EOB Must Go to Provider and Worker, Not Third-Party Payer
Friday, May 18, 2018 | 0
Third-party payers and networks are not health care providers, the Michigan Workers' Compensation Agency said in a reminder bulletin issued Thursday.
The state has seen an increase in the use of third-party payers and cost-containment networks, but explanations of benefits, or EOBs, may not be reaching the right people.
"The rules allow carriers and providers to utilize these networks if they choose," the bulletin said. "However, it is important to reiterate that the carrier or its designated agent must send a copy of the EOB to the provider and to the injured worker."
The EOB notifies parties about reimbursement adjustments and denials, explains why payment was adjusted, educates the worker on balance billing and outlines the provider's right to appeal payment adjustments.
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