Wis. ForwardHealth Online Handbook, Hospice, Topic #4822

Explanation of Benefit Codes in the Claim Header and

in the Detail Lines

EOB (Explanation of Benefits) codes are four-digit numeric codes specific to ForwardHealth that correspond to a printed

message about the status or action taken on a claim, claim detail, adjustment, or adjustment detail.

The claim processing sections of the RA (Remittance Advice) report EOBs for the claim header information and detail lines, as

appropriate. Header information is a summary of the information from the claim, such as the DOS (date of service) that the claim

covers or the total amount paid for the claim. Detail lines report information from the claim details, such as specific procedure

codes or revenue codes, the amount billed for each code, and the amount paid for a detail line item.

Header EOBs are listed below the claim header information and pertain only to the header information. Detail line EOBs are listed

after each detail line and pertain only to the detail line.

TEXT File

EOB codes and descriptions are listed in the RA information in the TXT (text) file.

CSV File

EOB codes are listed in the RA information from the CSV (comma-separated values) file; however, the printed messages

corresponding to the codes do not appear in the file. The EOB Code Listing matching standard EOB codes to explanation text is

available on the Portal for reference.