Electronic Explanation of Benefits (EOB) Frequently Asked Questions
Categories
- General Information
- Claims
- Member Services
- Enrollment and Access
- Remark Codes and Adjustments
- Appeals and Complaints
- Paper EOBs Availability
General Information
Claims
- If your doctor submits your claim, and it has been less than 15 days since the date of service, check My Account again in a few days.
- If it has been at least 15 days since the date of service, contact your doctor's office to make sure they submitted the claim.
- If you sent the claim yourself and it has been more than 15 days, double check your copy to make sure all of the information is correct (such as your member ID, group number, patient name, date of birth). If any information is incorrect, please send the claim again.
- If claims are still in pending status (not completely processed), please check back later to verify the claim is listed on the E-EOB once it is finalized.
- Select “Contact Us” in the top header of your My Account for more information on how to receive additional assistance.
- How soon your doctor or hospital submits the claim. Almost 80 percent of claims are received within 30 days from the date of service. In some cases, it can take up to 60 days before your doctor or hospital submits a claim.
- How quickly we process the claim once it’s received. More than 90 percent of claims are processed within 7 days of receiving them.
- Whether you have gone to an out-of-network doctor or hospital. If you have gone to an out-of-network doctor or hospital, two other factors may affect how long it takes to process your claim:
- Whether the doctor or hospital requires partial or full payment at the time of service.
- Whether the doctor or hospital can bill us directly or needs you to submit a medical claim form.
Member Services
Enrollment and Access
Remark Codes and Adjustments
Appeals and Complaints
Please check your health plan documents for the deadline to submit your appeal(s). On each level of appeal, a written response will be sent to you within the timeframe required by law. For plans that have two levels of appeal, a claim payment appeal is typically resolved within 30 days from the date we received your appeal request. There is a limit to the number of times you may appeal a decision. The limits are described in your plan documents, and the response will let you know if there are additional steps you can take. In the event you have exhausted your levels of appeal, the response you receive will notify you to that effect.
Paper EOBs Availability