What is the Explanation of Benefits Review?The Explanation of Benefits document (EOB) is the centerpiece of healthcare coverage communication and garners high level of consumer attention. For the first time in history, this most critical health insurance communication has undergone a national and comprehensive review.
The Mission:
- Enhance effectiveness & lower costs
- Using its decades of experience evaluating statements from all financial sectors, Dalbar, Inc. will undertake the review
The Benefits:
- Increase in consumer trust & satisfaction
- Decrease in consumer confusion & frustration
- Healthcare provider benefits from lower cost of operation
The Strategy:
- Create a highly visible and competitive advantage
- Improve understanding of the value of health benefits
- The results: increased market share & reduced cost
What is the EOB Review used for?
- Identify best practices
- Improve the EOB's effectiveness
- Reduce production costs or other related expenses such as:
- Volume of calls to the call center
- Volume of paper through better design
- Better understand and promote more expeditious use of healthcare services
- Support the case internally to redesign or update the EOB
- Promote success and create a competitive advantage where applicable
What is included in the Reports? Industry Report:
- Current trends and challenges in design and content
- Industry best practices and relevant recommendations
- Leadership qualities that distinguish the top ranked EOBs
- Ranking of Explanation of Benefits
- Criteria used to evaluate EOB
Executive Summary of Findings and your EOB’s Rating includes:
- The ranking your EOB achieves
- Industry benchmarks to provide context for your EOB’s score and rank
What Criteria was used? EOBs were evaluated and rated using Dalbar’s Evaluation Criteria. The Evaluation Criteria for EOBs are based on:
- Stakeholder Preferences
- Regulatory Requirements
- Industry Practice
- Communication/Design Best Practices
Each EOB is rated in three categories:
Clarity: Determines whether the content is presented in a manner that can be easily understood and is relevant.
Content: Determines if required content is included and whether additional content is presented in a way that will help readers put the EOB information into an overall context (e.g. targeted messaging).
Design & Available Formats: Evaluates elements that enhance the readability and comprehension of the statement, such as charts, icons, font size and style.
How do you submit your EOB?Dalbar offers healthcare providers the opportunity to submit an EOB and its supporting materials to be included in the rankings. Submitting an EOB enables us to evaluate your full capabilities and identify all of the features offered.
The following are tips for your submission. They are not requirements but do offer guidelines on what to submit:
- When making your submission online, please be sure to include the healthcare provider name and document type (e.g., “ABC Insurance EOB sample 1” or “ABC Insurance submission worksheet” or “ABC Insurance messaging”) in all document names
- EOB sample should include examples for all types of coverage including MD visits, prescription coverage, and hospital stays, if applicable
- Include examples of personalized messaging used within the past year
- Provide documentation of optional modules within the EOB
- Provide copies of EOB in full color
- All member information should be replaced with fictional information if using an actual member’s EOB
- Provide examples of different EOB formats, if offered
- Include a copy of the EOB guide given to members, if available.
- Display actual dollar values in numeric fields (rather than “xxxxxxx”). This allows us to see how calculations are made and judge their consistency
- Show a co-branded example if this feature is available
What is the Cost? There is no cost to submit your EOB for inclusion in the report. In return for submitting your EOB, you will receive the executive summary and your EOB’s rating on a complementary basis.
The comprehensive report costs $3,500.
However, if you have submitted your EOB for evaluation, the cost is $1,500.
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