Where does the explanation of benefits typically originate from?

Where does the explanation of benefits typically originate from?

• A. The healthcare provider
• B. The patient
• C. The payor
• D. The billing office

Answer: (C)

The explanation of benefits (EOB) typically originates from the payor, which is the insurance company or health plan responsible for reimbursing the healthcare provider for the services rendered to a patient. The EOB outlines the details of the medical claim, including what services were provided, how much of the claim was approved for payment, any deductions for copayments or deductibles, and any amounts that the patient may be responsible for. This document serves to inform the patient about how their claim was processed and what portion will be covered by their insurance, thereby providing transparency in the billing process. The payor generates this information after the claim is submitted by the healthcare provider and assessed by their claims processing system, ensuring that all pertinent details are communicated effectively to both the patient and the provider.

The explanation of benefits (EOB) typically originates from the payor, which is the insurance company or health plan responsible for reimbursing the healthcare provider for the services rendered to a patient. The EOB outlines the details of the medical claim, including what services were provided, how much of the claim was approved for payment, any deductions for copayments or deductibles, and any amounts that the patient may be responsible for.

This document serves to inform the patient about how their claim was processed and what portion will be covered by their insurance, thereby providing transparency in the billing process. The payor generates this information after the claim is submitted by the healthcare provider and assessed by their claims processing system, ensuring that all pertinent details are communicated effectively to both the patient and the provider.