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After submitting claims for medical and/or dental expenses, Fiserv Health - Kansas will send an Explanation of Benefits (EOB) that illustrates how the claim was processed. The attached sample EOB illustrates how Fiserv Health - Kansas identifies eligible expenses, the actual EOB you receive may have expanded information in some fields:
Click on a number for a description of the function indicated.
1. Customer Service Number
This is the customer service number for the group under which the claimant is covered. This is conveniently located at the top of the EOB so it is easy to find. Refer to the actual phone number on your EOB to contact our office.
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2. Claim Identifiers
Important information about the claim is shown near the top of the form. These identifiers include Group Number, Patient name, Employee name, Patient #, Claim number, EOB date and Check #.
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3. Claim Summary
Summary information detailing payments made on this claim.
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4. Charge Line Detail
The charge line detail contains the dates of service, provider and type of service, submitted charges, negotiated discount write-offs, charges not covered, co-payment amounts, deductibles, co-insurance and amounts paid. The information is shown in a single line for each type of service flowing through each step to arrive at the total benefit amounts. The total for each column of detail is shown at the bottom of the chart.
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5. Explanation Codes
Explanation codes, if any are reflected on the claim, are shown in the charge line detail of the EOB. This area provides definitions for the explanation codes.
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6. Deductible and Coinsurance Accumulators
Benefit history for deductible and coinsurance amounts met for the current plan year are shown for Single and Family totals. The amounts shown under Single are specific to the patient identified on the EOB.
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7. Patient Responsible Total
Claim messages are centralized together.
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