Explanation of Benefits / Explanation of Payment

The explanation of benefits (EOB), and explanation of payment (EOP) must reflect the reconciliation between the provider charges and the payment. In addition, it must indicate the CHA Network savings or discount amounts, and the amount due from the member. If an affiliated network is being utilized, then the appropriate affiliated network should be identified on the EOB/EOP and also reflect the savings or discounted amounts.

An explanation of benefits and explanation of payment MUST be provided, regardless of the payment amount. This would include any Zero paid amounts to providers and members.

A sample copy of the EOB/EOP will need to be provided to Community Health Alliance prior to the group’s effective date.

Disclaimer: This information is for informational purposes only and is not intended to constitute professional advice as circumstances may vary. CHA is not liable for information contained on this site. Fee schedule information applies only to M.D.s and D.O.s, not to any other Allied or Behavioral Health providers. CPT code allowables are global and do not represent modifiers. Information contained on this website is subject to change.