An EOB is a document sent by insurance companies that explains how a claim was processed. Generally, it indicates what was paid and/or what was denied. Most insurance companies use their own format for EOBs. The following table lists some common language and information found on EOBs.

EOB Term

Description

Account Number

A number assigned to each bill by the provider of services; Sonora Quest Laboratories uses the term “accession.”

Amount Paid

The portion of the total bill that has been paid by the insurance carrier.

Allowed Charges

The amount the insurance company approved for processing.

Capitation Accounts

These are insurance companies (HMOs, IPAs, etc.) who generally pay a fixed rate based on a number of members per month and/or volume of tests. Capitated payors usually provide services for HMOs.

Claim Number

The number assigned by an insurance company to a particular patient’s bill; this number is often provided on the insurance company's response to Sonora Quest Laboratories.

Coinsurance

The portion of the allowed charges (usually a certain percentage) that is the patient’s responsibility.

Contractual Allowance

The portion of the total bill that is NOT owed to Sonora Quest Laboratories (by the insurance company and/or the patient); this amount is based on the contractual agreement between the insurance company and Sonora Quest Laboratories.

Coordination of Benefits

Indicates the amount owed by another insurance company when the patient has additional insurance coverage.

Copay

The amount required to be paid by the patient.

CPT Code

The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel which describes the laboratory services that were performed.

Date of Service

The date on which the laboratory testing was performed.

Deductible

A specific annual dollar amount that must be paid by the patient before the patient’s insurance will begin reimbursing for covered services.

Explanation of Payment

The section of an EOB that details how payments were made and explains any payment codes used.

Non-covered

A specific service that is excluded from a patient’s policy plan coverage and is considered non-payable by an insurance company. The patient may be responsible for this amount.

Patient Information

Various information including patient name, patient ID number, responsible party, subscriber, insured’s name, employee’s group number.

Patient Responsibility

Amount that the insurance has indicated the patient owes provider (Sonora Quest Laboratories). This includes "not covered" amounts, "deductible amounts," and any co-insurance, if payment is less than 100%. Note: Although copays are not a part of this calculation, they are also the patient’s responsibility.

Provider Information

Payee Sonora Quest Laboratories name and mailing address. Additionally, may include account number on the claim, provider number and the name of the provider.

Submitted Charges

The amount Sonora Quest Laboratories billed for service provided.

Units

The number of items included in this service.

UCR

Stands for usual, customary and reasonable and refers to fees for services.

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