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- Billing Explained
An EOB is a document sent by insurance companies that explains how a claim was processed. Generally, it indicates what was paid and/or what was denied. Most insurance companies use their own format for EOBs. The following table lists some common language and information found on EOBs.
| Term: | Description: |
|---|---|
| Account Number | A number assigned to each bill by the provider of services; Columbia University Pathologists uses the term “Invoice#.” |
| Amount Paid | The portion of the total bill that has been paid by the insurance company. |
| Allowed Charges | The amount the insurance company approved for processing. |
| Capitation Accounts |
These are clients (HMOs, IPAs, physicians, etc.) who generally pay a fixed rate based on a number of members per month and/or volume of tests. Capitated clients usually provide services for HMOs. |
| Claim Number | The number assigned by an insurance company to a particular patient’s bill; this number is often provided on the insurance company’s response to Columbia University Pathologists. |
| Coinsurance | The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility. |
| Contract Charges | The portion of the total bill that is NOT owed to Columbia University Pathologists (by the insurance company and/or the patient); this amount is based on the contractual agreement between the insurance company and Columbia University Pathologists. |
| Coordination of Benefits |
Indicates the amount owed by another insurance company when the patient has additional insurance coverage. |
| Copay | The amount required to be paid by the patient. |
| Date of Service | The date on which the laboratory testing was performed. |
| Deductible | A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services. |
| Excess over UCR | The portion of the total charges that is greater than the allowed charges; this amount is based on the contractual agreement between the insurance company and Columbia University Pathologists. “UCR” stands for usual, customary and reasonable. |
| Explanation of Payment |
The section of an EOB that details how payments were made and explains any payment codes used. |
| IPA | Independent Practice Association |
| Non–covered | A specific service that is excluded from a contract and is considered non–payable by an insurance company. The patient may be responsible for this amount. |
| Patient Information | Various information including patient name, patient Id number, responsible party, subscriber, insured’s name, employee’s group number. |
| Patient Responsibility |
Amount patient owes provider (Columbia University Pathologists). This includes “not covered” amounts, “deductible amounts,” and any percentage of balance, if payment is less than 100%. Note: Although copays are not a part of this calculation, they are also the patient’s responsibility. |
| Provider Information |
Payee (Columbia University Pathologists’s) name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider. |
| Service Code | A code representing the service provided. |
| Submitted Charges | The amount Columbia University Pathologists billed for service provided. |
| Units | The number of items included in this service. |
| UCR | Stands for usual, customary and reasonable and refers to fees for services. |