Create EOB

Create an explanation of benefits (EOB).

myAvatar MSO > Claims Processing > Create EOB

• This form defines the maximum reimbursement per EOB.
• EOBs reconcile claims submitted by providing contractors.
• Services must be included on a voucher before an EOB can be created that contains the service.
• Multiple vouchers can be contained in a single EOB.
• An EOB must contain at least one voucher.
• Vouchers cannot be split between EOBs.

Prerequisites:

• User must be assigned to a User Role authorized to (run, file/submit, view) Create EOB.  
• User must be logged into Avatar.  
• At least one voucher must be created for the provider you are creating the EOB for.

 1. In the All Or Individual Providers field, select Individual to choose specific providers.

2. In the Provider field, select the providers to create EOBs for.

• This field contains providers associated with a voucher, and that are not contained in any current EOBs.

3. If applicable, in the Maximum Dollar Amount Per EOB field, enter the maximum dollar amount that can be included in the EOB.

• This amount must be equal or greater than the maximum dollar amount per voucher.

4. If applicable, in the Maximum Dollar To Pay In This Compile field, enter the maximum dollar amount to distribute for the current form session.

• This amount must be equal or greater than the maximum dollar amount per EOB.

5. In the Segregate EOB To field, select whether the EOBs to be created will include only Approved Vouchers or only Denied Vouchers. If no value is selected, the EOBs will include both.

6. To restrict EOB to vouchers created prior to a certain date, enter a date in the Include Services With Date Of Voucher Creation Prior To field.

• Batches where the date entered in the Date Claims Received field (Batch Creation form) is the current date, or earlier can be included in the EOB.
• If this field is blank, all vouchers will be included in the EOB.

7. In the Readjudicate Services Previously Pended Due to Depleted Monthly Max field, select Yes to have the system look for services that were previously pended with a reason of "Provider monthly dollar max has insufficient remaining funds for service." If any services are found, and any dollars have been left undistributed in the intervening months, those dollars can be distributed against these previously pended services and the services approved for claiming.
8. Click Submit.

► Additional section

• Other EOB Information

► Registry settings

• Create EOB by Fiscal Year

• Provider Adjustment (PLB)

• Segregation of Batches

► SQL table

• SYSTEM.table_eob_core