Posting paper EOBs and insurance checks

How to post a paper EOB and check

1. 1

   Open the mail the day it arrives

   Log every insurance check and EOB with the date received, the payer, the check number and the amount.

   The log is what turns a pile into a number. Without it, nobody can say how much insurance money is sitting unposted, and a check can clear the bank weeks before its EOB is read.

2. 2

   Pair each check with its EOB

   Most checks arrive with the EOB that explains them. Some EOBs arrive alone, with the payment sent by EFT or another check.

   Note which EOBs have no check in the envelope, and which checks pay claims for several patients. Both need a different path from the simple one-check, one-claim case.

3. 3

   Post every line to its claim

   In the practice management system, apply the paid amount, the contractual write-off and the patient’s share to each procedure on the claim.

   A check that pays a dozen claims is posted claim by claim, each with the same check number. Denied and short-paid lines go to a work list with the reason code and the appeal date; check each payer contract for the window.

4. 4

   Deposit the check

   Endorse it and deposit it the same day, in person, by remote deposit or through a lockbox.

   Keep the check number on the deposit so the bank line can be traced back to the EOB later.

5. 5

   Match the deposit to the posting

   Confirm that what was posted for each check equals what reached the bank, and book the deposit to your accounting system.

   A check that was posted but never deposited, or deposited but never posted, is found here or at month end. Here is cheaper.

6. 6

   Store the paper securely

   EOBs carry patient health information. Scan them, keep the image with the claim, and store or shred the originals under your HIPAA policy.

   A scanned EOB attached to its claim also makes the next appeal faster: the evidence is one click away.

System-specific notes: Dentrix, Eaglesoft and Open Dental.

In-house, lockbox or PO Box: the options compared

There are three ways to take paper off the front desk. They differ most on the last two columns: whether anyone posts the EOB into your practice system, and whether anyone proves the deposit matches.

Whichever you choose, put the same questions to it:

1. Who opens the mail, and how fast is each envelope scanned?
2. Where does each check get deposited, and how does the deposit show on the bank statement?
3. Do EOBs come back as images, or are they read into data line by line?
4. Does anyone post the EOB into our practice management system, per procedure?
5. Who matches each check to its EOB and to the bank deposit?
6. What happens to an envelope that is not an EOB or a check, such as a refund request?
7. Will you sign a Business Associate Agreement?

How to move payer mail to a new address

Moving to a lockbox or PO Box means changing the address each payer sends payments to. Payers handle this differently, often through the provider record or a change form, so check each payer’s process and keep a list of who has confirmed the change.

Expect stragglers. Some payers take a few cycles to switch, so keep checking the office mail for insurance envelopes until every payer on your list has confirmed.

How to get less paper

The cheapest paper EOB is the one that never arrives. For every payer still mailing checks, ask for EFT and enroll for the ERA at the same time, so each deposit comes with an 835 file and a trace number to match it. See EFT and ERA enrollment. Some payers will offer a virtual card instead of EFT; you can usually ask for EFT.

A few payers will keep mailing no matter what. Plan for a small, steady stream of paper, and give it a path that does not depend on someone finding a quiet afternoon.

Run this every day paper arrives:

1. All mail opened and every check and EOB logged with the date received.
2. Every EOB posted per procedure, or on the work list with a reason.
3. Every check deposited, with its check number on the deposit.
4. Each deposit matched to what was posted for it.
5. Scans attached to their claims; originals stored or shredded under policy.

How ScoutIQ handles it

Payers mail EOBs and checks to a ScoutIQ PO Box, where they are opened and scanned. ScoutIQ reads each EOB line by line, with a confidence score per line, and posts paid amounts, write-offs and patient responsibility to your practice management system, one of 59 it supports. The same queue takes ERAs from your clearinghouse, staff uploads and the payer portals ScoutIQ checks.

95% of insurance payments match their EOB with no human review (see the data page). Every check is matched to its deposit and booked to QuickBooks or Xero: see reconciliation. Short pays and denials go to your team with the payer’s reason and the days left to appeal. Most practices are live in 48 hours.