Dear Provider,

The Explanation of Payment (EOP) is now easier for you and your staff to review which means allocating the proper payments is simplified!

The enhancements to the EOP include:

Changes:

• Claim level totals are populated. In the past only the billed amount and paid columns were shown.

• Claim totals are broken down for each provider listed on the EOP. This will help you allocate the payments to the provider who performed the service(s).

• Effective March 4, 2009: The EOP will display interest amounts in the Header, Provider Totals and Vendor Totals sections of the form. Interest will be paid accordingly and a remittance advice is sent along with payment to the provider, making this process more convenient for the providers, the Centers for Medicare and Medicaid Services (CMS) and the Georgia Department of Community Health (DCH).

Additions:

• The grand total labeled as Vendor totals includes a summary for billed, allowed, co-pay/co-insurance, other carrier, interest and paid amounts.

• The co-pay/co-insurance amount at the claim level total is populated, when Total PR (Patient Responsibility) is populated in the header row of a claim. This is more convenient for the provider, Centers for Medicare and Medicaid Services (CMS) and other entities.

Please download the attachment provided for a sample of the new EOP with the enhancements pointed out.

If you have any questions or suggestions regarding the EOP enhancements, please contact your Provider Relations representative or call the Provider Hotline at (866) 231-1821.

Sincerely,
WellCare of Georgia, Inc.