Enter Three or More EOMB Codes Per Line Item
In this scenario, the insurance company paid a portion of the office visit. The EOMB indicated multiple adjustments because the fee schedule maximum allowable was exceeded and a prompt pay discount was applied. The remainder is the patient responsibility.
Note: Extra steps are required when there are two
or more EOMB adjustment codes, either with the same or different group code.
Add a separate line for each additional adjustment code. Enter the adjustment
or denial reason code in EOMB and leave EOMB2 blank until the last code for the
line item has been entered.
Example:
- Total OV charge: $152.14
- Primary insurance paid: $75.00 (EOMB CO45 - Charge Exceeds Fee Schedule Maximum Allowable by $25.00)
- Primary insurance discount: $15.00 (EOMB CO44 - Prompt Pay Discount)
- Patient responsible for balance $37.14
- The payment of $75.00 and the first adjustment of $25.00 will be applied first
These steps presume that SYSTOC and SYSTOC_EDI settings are correct before EOMB codes are applied. It is also presumed that the primary and secondary insurance information and the relationship to the subscriber have been documented, as well as the relationship to the patient if there is an alternate subscriber.