The four-digit explanation of benefits (EOB) codes and the corresponding narratives indicate that the submitted claim paid as billed or describe the reason the claim suspended, was denied, or did not pay in full. Because a claim can have edits and audits at both the header and detail levels, EOB codes are listed for header and detail information when applicable. The Remittance Advice (RA) lists a maximum of 20 EOBs for the header and a maximum of 20 EOBs for each detail line. Exceptions are suspended claims, which have a maximum of two EOBs per header and per detail. EOBs for suspended claims are not denial codes, but list the reason the claim is being reviewed.
Any applicable EOB codes are reported in the Claim Adjustments, Claims Denied, Claims Paid, and Claims in Process sections of the RA. EOB codes are listed immediately following the claim header and detail information, in a field marked EOBS. A three-digit label at the beginning of each line of EOBs indicates which part of the claim the EOBs in that line pertain to, as follows:
- The line labeled 000 lists the EOB codes related to the claim header.
- The line labeled 001 lists the EOB codes related to the first claim detail.
- The line labeled 002 lists the EOB codes related to the second detail line (and so on, for all subsequent details).
If no EOBs were posted for the header or for a particular detail of the claim, the corresponding EOB line does not appear on the RA.
Narrative descriptions of the EOB codes used on an RA appear in the EOB Reason Code Descriptions section of the RA.
EOBs are considered local codes and are not transmitted in the 835 electronic transaction. Instead, Health Insurance Portability and Accountability Act (HIPAA)-compliant codes are transmitted in the 835 transaction.
Providers can access all EOB codes and descriptions on this site for reference.