Enter Two or Fewer EOMB Codes Per Line Item

In this scenario, the total charges are for an office visit and an x-ray. The primary insurance paid a portion of the office visit and the x-ray charge. The EOMB indicated adjustments for exceeding the fee schedule maximum allowable. The remainder is the patient responsibility.

Example:

Office Visit:

  • Total OV charge: $112.40
  • Primary insurance paid: $50.00
  • Adjustment: EOMB CO45 - Charge Exceeds Fee Schedule Maximum Allowable by $40.00
  • Patient responsible for balance $22.40

X-ray:

  • Total x-ray charge: $42.93
  • Primary insurance paid: $20.00
  • Adjustment: EOMB CO45 - Charge Exceeds Fee Schedule Maximum Allowable by $15.00
  • Patient responsible for balance $7.93

The steps below 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.

  1. Navigate to Billing Folder > Receipts/Adjustments.
  2. Click the Insurance radio button. Browse and select the appropriate insurance plan from the Payment from Ins Plan ID lookup.

  3. Click Continue to Invoice Search.
    The Search for Invoices screen displays. Search for the correct invoice using the normal SYSTOC procedure.
  4. Click Next to Pay Charges.
    The Pay Charges screen displays.
  5. Apply the payments and adjustments.
  6. Scroll to the right on the Pay Charges screen to see the EOMB fields.
  7. Enter the EOMB codes for each line item.
    1. EOMB: Enter the code for the adjustment or denial.
    2. EOMB2: Enter the code for the person or entity responsible for the remaining balance.
    The table below describes using the two EOMB fields depending on the balance remaining to be paid:
    Line Item has... EOMB Field EOMB2 Field
    Remaining balance after payment and adjustment. Enter the adjustment or denial reason code. Enter the appropriate code for person or entity responsible for remaining balance.
    Zero balance after payment and adjustment. Enter the adjustment or denial reason code. Leave blank.
    Zero balance after payment. Leave blank. Leave blank.
    The payment, adjustment, and remaining balance for each line item must equal the total line item charge. The claim will be rejected if payments and adjustments do not equal the total charge on the 837 claim file.

  8. Click Commit.
    The Invoices with Balances screen displays.
  9. Select the next responsible party from the drop-down list.

  10. Click Commit to complete the data entry.
    The claim transmits to the secondary payer when processed.