Skip to main content

Other EOB Information

  1. Last updated
  2. Save as PDF

Enter information filed in the Create EOB form after an EOB has been created.

  1. Go to: Avatar MSO > Claims Processing > Other EOB Information.

  2. In the All Or Individual Providers field:

  • Select All to include EOBs for all providers.

  • Select Individual Providers to include EOBs for a specific provider.
    If Individual Providers is selected, in the Provider field, select the provider.

  1. In the EOB Date From and EOB Date To fields, enter the date range.

  2. In the Select EOB field, select the EOB to add information to.

  3. The Check/EFT Date field displays the date entered in the Create EOB form. Edit as necessary.

  4. The Check/EFT Number field displays the check number entered in the Create EOB form. Edit as necessary. This field will default in the Provider Adjustment Identifier (PLB-03-02) if the EOB amount is negative.

  5. The Check/EFT Amount field displays the check amount entered in the Create EOB form. Edit as necessary.

  6. In the Fiscal Period Date (PLB-02) field, enter the fiscal period date that will be inserted in the PLB-03-01 on the outbound 835 file for the EOB.
    Enter the date in in the MM/DD format.
    This field will be disabled if multiple contracting providers are selected in the Provider field.
  7. In the Adjustment Reason Code (PLB-03-01) field, enter an adjustment reason code that will be inserted in the PLB-03-01 on the outbound 835 file for the EOB. This will default to the Forwarding Balance if there is a forwarding balance on file for the provider.
    This field will be disabled if multiple contracting providers are selected in the Provider field.
  8. In the Provider Adjustment Identifier (PLB-03-02) field, enter an adjustment reason identifier that will be inserted in the PLB-03-02 on the outbound 835 file for the EOB. This field will display multiple identifiers if the EOB has multiple PLB segments on the outbound 835.
    If no value is entered, the PLB-03-02 will be set to the same value reported in the TRN-02 segment of the generated 835.
  9. In the Provider PLB Amount field, enter an adjustment reason code that will be inserted in the PLB-03-01 on the outbound 835 file for the EOB.
    • Any value entered here will be used to calculate the BPR-02 segment.
    • If the amount entered here will cause the BPR-02 to be negative, an error will be returned informing the user.
    • If an advanced payment is found in the 'SYSTEM.Provider_PLB_Amount' table for the provider then it will populate in this field, as long that value will not cause the BPR-02 amount to be negative.
    • This field will be disabled if multiple contracting providers are selected in the Provider field.
    • If there is a Maximum Amount on EOB value being filed, the 'Provider Adjustment Amount (PLB-04)' will be recalculated when this form is filed, to verify that the BPR02 amount is not negative.
    • If multiple EOBs are being created, the PLB segment fields will be filed only for the first EOB created. The new PLB fields will not be filed for any batches that did not originate on an 837.

  10. Select Submit.

► Additional Sections
► Registry Settings