EOBs: Alert! Missing Remittance Advice
The national class-action settlement agreements require that reason codes be on EOBs. The Horizon agreement is in effect and failure to provide the reason code violates the agreement. Members are urged to inform MSNJ of any Horizon plan EOBs that do not contain reason codes. Please write to email@example.com and put “Horizon: EOB Compliance Dispute” in the subject line. Please indicate the plan name and for how long the EOBs have been missing this information. If the EOBs contain inaccurate information, particularly about patient responsibility, please provide that information, too. We have learned that some of Aetna’s EOBs are dropping the reason code. It is not clear if this is an isolated situation. Please write to firstname.lastname@example.org if you receive EOBs that are missing the reason code. Please put: “Aetna: EOB remittance advice” in the subject line.