For bills submitted electronically, ebilling rules require a claims administrator to transmit electronic explanation of reviews (EORs) also known as an 835. Upon receipt of an electronic EOR, DaisyBill immediately posts it to the indicated bill.
You’ll find 835 electronic EORs listed in the Explanations of Review - EOR section of a bill.
In addition to transmitting 835 electronic EORs, claims administrators also mail duplicate paper EORs to the provider.
Note: For electronically posted EORs, do not post the paper EOR. This will create a duplicate posting. Instead, maintain a precise record of reimbursement by uploading the paper EORs to all electronically posted bills.
Step 1. From the Bill Page, scroll down to ‘Explanations of Review - EOR’
Step 2. To view an electronic EOR, click ’835’ under ‘Electronic EOR’
Note: a paper EOR posted to a Bill may display a link to an 835 if an 835 matching the paper EOR was received after the paper EOR was posted. This avoids duplication of payments.
Step 3. Review the electronic EOR
Electronic EORs require the use of standardized explanation codes called Claims Adjustment Reason Codes (CARCs). CARCs are returned by claims administrators in the 835 file.
DaisyBill crosswalks CARCs to the appropriate Remittance Advice Remark Code (RARC) when available and displays the RARC definition. RARCs are part of the commonly adopted ebilling standard (per the IAIABC), but are not required for use in all states. Not all CARCs are associated with a RARC.
For California claims, DaisyBill additionally crosswalks the appropriate Bill Adjustment Reason Code (BARC). BARCs are specific to California and provide even further detail on claim processing. BARCs are displayed in blue when present.
Now you’re getting the hang of it!