Typical sequence
1
Provider submits claim
Service and coding information is sent to the plan.
Service and coding information is sent to the plan.
2
Plan processes claim
Network rules, benefits, adjustments, and coverage are applied.
Network rules, benefits, adjustments, and coverage are applied.
3
EOB is issued
The plan explains how the claim was processed.
The plan explains how the claim was processed.
4
Provider bills remaining amount
The customer compares the bill with the processed claim.
The customer compares the bill with the processed claim.
Common EOB fields
- Amount billed
- Allowed or negotiated amount
- Plan payment
- Network or contractual adjustment
- Deductible applied
- Copay or coinsurance
- Amount listed as patient responsibility
- Reason or adjustment codes
When to ask questions
- The provider bill exceeds the patient responsibility shown for the same processed claim
- A service appears out of network unexpectedly
- The claim is denied or marked as needing information
- The service, date, or provider appears incorrect
- A duplicate claim or duplicate bill appears
How CareAnything will use this later
These public guides are structured so verified provider, insurer, price, availability, and customer-authorized data can later be inserted from the CareAnything database and APIs without changing the customer journey.