1) There are two separate processes for posting EOB’s in EMR Bear:
a. Manual EOB’s
i. This includes denials, checks, etc. received via mail, or research on the portals for missing payments/denials.
i. Includes electronic remittance received from the clearing house.
2) All posting is completed under the EOB tab in EMR Bear.
Under the billing drop down menu select EOBs.
The EOB screen will show all unprocessed EOBs that were loaded either manually or by 835.
3) Processing 835
a. On the right-hand side of the screen is a view button.
i. The view button allows a review of the EOB prior to posting, this is strongly suggested to review denials and correct errors on the EOB like denials posted as adjustments or reductions (issues like this comes from the payor).
ii. Apply all button allows the EOB to be posted as is with no review. This is not recommended.
iii. The red trash button should only be used for rare circumstances, like duplicate EOBs. Again, not recommended.
b. Open the EOB with the View button.
i. Several items that appear at the top of the screen.
1. EOB – this is the EOB# that is auto assigned in EMR Bear, when the 835 is uploaded.
2. Date Received - this is the date that check was received from the clearing house.
3. Payor – The payor defaults to what the is sent from the payor (in this example Presbyterian Centennial). The pencil beside the payor name allows for the payor to be changed (i.e., Presbyterian Centennial to Presbyterian Commercial).
a. Most of the payor name changes happen between Medicaid plans, Commercial and a Medicare plan when a provider has multiple contracts under a payor.
4. Payment – this is the amount of all payments for the check.
5. Check Amount – this is the actual amount of the check (this may be different than the payment amount if there are recoupments or additional payments for corrected claims).
6. Adjustments – this is the amount of adjustments between the billed amount and the allowed amount. Always double check the adjustments since the payors will send over a denial as an adjustment. This can be corrected on the individual lines.
7. Deductions – deductible amount that is client responsibility.
8. Copays – normally nothing appears in the field.
9. Client Responsibilities – this will show client copays/coinsurance
10. Denials – amount of denials appear here.
11. Reductions – amount that the payor is saying are reductions. Work of caution here, if the amounts are posted as reductions, it shows the balance on the account as double what the original charge amount was. 9 times out of 10 this is a denial and can be adjusted on the individual line.
12. Unapplicable on 835s this normally does not apply.
13. Totals – this shows the total of all the columns for amount, applied and balance.
14. Check number – this is the check number from the payor.
15. Check date – this is the check date from the payor.
a. This is important for several reasons. Calling payors for additional information on a check they will ask for the check number and check date.
b. For the clients this is beneficial for the balancing of the deposits, most accounting departments will utilize the check date, check number and check amount for balancing.
i. Scroll down the page to the Progress section
16. This shows all the claims that are paid on the check.
17. Under the payor column: This will show the payors that were billed on the individual bill cases.
a. This provides the information on whether the payor name will be changed. (i.e., Presbyterian Centennial to Presbyterian Commercial).
3. The progress provides the information on how each bill case was processed on the check+
is good, this means a payment on the bill case.
this is the adjustments. Again, just confirm that if there is only an adjustment on the bill case line that it should be updated to a denial (i.e., only line shown is a CO 96 – this is a denial as non-covered.) (CO-45 with a payment will stay as an adjustment, same with the CO-131, both are adjustments.)
i. The drop down that shows how the line will be posted can be changed. Simple click on the down arrow and select the proper placement for the posting.
4. Once all the bill cases have been reviewed for the EOB the final step is applying the transactions in the EOB.
5. At the bottom of the screen, two important items are located.
a. Process 1 page of x
. This provides the information on how many pages of transactions were processed on the EOB. Important to check each page.
b. Second part is Apply all transactions in the EOB. Once all transactions are reviewed this is the button to select to allow the system to post the check to the bill cases.
i. Select perform action and the EOB will post the amounts to the transactions.
4) Posting Manual EOB’s
a. Manual EOBs will come from multiple sources:
i. Paper checks, denials via mail, or reports pulled from the portals for missing remits.
b. From the billing drop menu select EOBs:
c. On the EOBs screen select:
d. The pop up for enter new EOB will appear.
i. Date received – this is the date the check/denial was received (i.e., 07.01.2022).
ii. Payor – from the drop down, select the payor for the check/denial.
iii. Attached file – this allows for the check/eob/denial to be attached to this posting.
Note: This will save hours of research when dealing with audits.
iv. No check is always marked when opening the screen.
1. Uncheck the no check and enter the check number, check amount and check date.
i. Adjustments – total adjustments from check/denial.
ii. Deductible amount – amount applied to client deductible.
iii. Copay amount – leave this blank.
iv. Payment amount – this is the amount of payment amount received.
v. Denied amount – total of all denials on check/denial.
vi. Client responsibility – enter client’s copays/coinsurances here.
vii. Payor reductions – leave this blank.
viii. Total amount (sum of the above) – this auto sums.
ix. Provider level adjustments – leave this blank.
g. Once the information is entered click on create EOB.
h. The EOB should appear like this:
i. To post the check/denial, under search bill case by EMR-bear ID: enter the bill case.
ii. The bill case will appear, select the bill case.
iii. The screen will appear as below allowing for posting of paid, deducted, adjusted, copaid, wr-off, cl res, cl pay, redu, denied.
- Paid = Payment
- Deducted = Deductions
- Adjusted = Adjustments
- CL Res = Client Responsibilities
- Denied = Denials
k. Enter the information from the payment/denial by clicking on the corresponding blue plus button. (i.e., deducted = deductible).
l. The next pop-up screen will appear allowing for the input of the information.
1. Group code drop down:
2. Reason code is the numeric or alpha code provide with the group code.
when entering the deductible, copay, or coinsurance. Start typing the word for each of them and it will provide the corresponding number.
3. Amount – this is the amount for each item being entered.
i. Example of adding the posting is below:
a. Once the information is added, select the blue button at the bottom Add Deductible
and that completes that line of posting.
1. This will continue until all lines are posted from the EOB.
2. Once the EOB is posted the balance column at the top will be all $0.00’s.
This process will be repeated for each manual EOB that needs to be posted.