Other EOB Information Section

Enter other EOB information.

Avatar MSO > Claims Processing > Create EOB

1. In the EOB Date field, enter the date.

• This date is used for the check, or 835 file.
• If this field is blank, the date the EOB was created is used.

2. In the Check/EFT Date field, enter the date.

3. In the Check/EFT Number field, enter the check number. This field will default in the Provider Adjustment Identifier (PLB-03-02) if the EOB amount is negative.

4. In the Check/EFT Amount field, enter the check amount.

5. 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.
6. 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.
7. 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.
   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.
8. 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 as 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.

9. Click Submit.
   
   A dialog displays the EOB number, and total dollar amount.