Explanation of Benefits (EOB)

Explanation of Benefits (EOB)

The four-digit explanation of benefits (EOB) codes and the corresponding narratives describe the reason submitted claims suspend, deny, or do not pay in full. Because a claim can have edits and audits at the header and detail levels, EOB codes are listed for header and detail information. The header lists a maximum of 20 EOBs, and each detail line lists a maximum of 20 EOBs. Exceptions are suspended claims, which have a maximum of two EOBs per header and per detail. EOBs for suspended claims are not denial codes, but list the reason the claim is being reviewed.

On the Remittance Advice (RA), EOB information is listed immediately following the claim header and each claim detail line, along with the applicable EOB caption. Caption EOB 000 lists EOB codes and descriptions related to the claim header; caption EOB 001 lists the EOB codes and descriptions related to detail line one; caption EOB 002 lists the EOB codes and descriptions related to detail line two; etc. If there are no EOBs posted for a particular EOB XX line, the line does not print. The Health Insurance Portability and Accountability Act (HIPAA) compliance codes, rather than EOBs are transmitted in the electronic 835 transaction.

Providers can access all EOB codes and descriptions on this site for reference.