Explanation of Benefits (EOB)
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Electronic EOB Overview (E-EOB)
An Electronic Explanation of Benefits or E-EOB is a weekly summary of medical and dental claims that have been processed by CareFirst and CareFirst BlueChoice. E-EOBs will display details about claims processed for you, your spouse and/or dependents (if applicable).
E-EOBs are available in My Account and have been redesigned to help you easily understand the claims that are processed in a weekly time period. E-EOBs can be viewed online and printed at your convenience.
Sometimes an email from a new sender will automatically go to your spam or junk mail folder. To avoid this, when you receive an email from CareFirst, add the sender email to your address book or safe senders list. See your email program's “Help” option for the proper location. Members must verify their email address and opt-in to receive electronic forms of communication. Go to My Profile within My Account to update your email address and consent.
The document number is a unique identifier that is generated for each E-EOB so that it can be easily referenced and searchable online.
Although the information in each E-EOB is very similar, the format and availability of EOBs on the HCBO website and My Account may vary.
You will be able to view medical and dental services.
If the claim doesn't appear in the list after searching, here are a few things to try:
- If your doctor submits your claim, and it has been less than 15 days since the date of service, check My Account again in a few days.
- If it has been at least 15 days since the date of service, contact your doctor's office to make sure they submitted the claim.
- If you sent the claim yourself and it has been more than 15 days, double check your copy to make sure all of the information is correct (such as your member ID, group number, patient name, date of birth). If any information is incorrect, please send the claim again.
- If claims are still in pending status (not completely processed), please check back later to verify the claim is listed on the E-EOB once it is finalized.
- Select Contact Us in the top header of your My Account for more information on how to receive additional assistance.
Each claim is different and processing times will vary. The length of time it takes to process a claim depends on these factors:
- How soon your doctor or hospital submits the claim. Almost 80% of claims are received within 30 days from the date of service. In some cases, it can take up to 60 days before your doctor or hospital submits a claim.
- How quickly we process the claim once it’s received. More than 90% of claims are processed within seven days of receiving them.
- Whether you have gone to an out-of-network doctor or hospital. If you have gone to an out-of-network doctor or hospital, two other factors may affect how long it takes to process your claim:
- Whether the doctor or hospital requires partial or full payment at the time of service
- Whether the doctor or hospital can bill us directly or needs you to submit a medical claim form
The amount paid is only displayed for medical claims that have been processed. The other claims shown are still being processed (pending) or have been denied.
Only the registered subscriber can access E-EOBs through My Account.
If you are a registered user of My Account, you can log in and visit the EOB section of the site under Claims.
You can visit the CareFirst website to register for My Account. Once online you can choose to receive weekly E-EOB notifications.
In some cases, there are confidentiality reasons why certain family member information is not available in an E-EOB. If there are no confidentiality reasons, as the subscriber, you have access to all E-EOBs for claims processed for you and your family by viewing, saving and/or printing a copy of the weekly summary.
You can access an E-EOB on My Account as often as you like.
Once available, E-EOBs will be accessible online for as long as three years.
Select Contact Us or Send Us a Secure Message in the top header of My Account to send a secure email to Member Services. You can also call the number on the back of your ID card to obtain a copy of an E-EOB that is no longer available online.
Yes. While E-EOBs will be available online in the fall of 2011, any E-EOBs created prior to your access to My Account site will not be included.
You may contact Member Services at the telephone number listed on your ID card to obtain a paper copy of an EOB. You can also print a copy of your E-EOB from the My Account site.
Yes. At any time you can visit My Account to change your email notification preference. If you choose not to receive email notifications, you will begin to receive EOBs via the U.S. Postal Service.
Update your email preferences by changing your communication preferences within My Account. Click your name in the top right corner and select Communication Preferences. Then select Edit next to electronic communications and select the box next to email to go paperless. Make sure to save your changes.
Once you sign up for E-EOB email notifications, in most cases you will no longer be mailed EOBs to your home via the U.S. Postal Service. In the instance that your EOB includes a check made payable to you, the subscriber, you will receive the EOB via the U.S. Postal Service. If an email alert is attempted and fails for any reason, you may also begin to receive your EOBs via the U.S. Postal Service.
On the E-EOB there will be a column noted as REMARK CODE. A remark code is typically a 4-digit number that references a special note on the E-EOB.
The remark code explanation is found at the bottom of the E-EOB after all claims have been listed. It is in these explanations that the EOB will note if an adjustment has been made.
Questions that require phone support
The following questions are best answered by one of our Member Services experts.
- How do I get immediate help with a change in my membership?
- When will I get my new member ID cards?
- How do I get proof of coverage or a letter of credible coverage?
- How do I get help if I’m having technical issues with the website?
Support & Service
Need help with your plan?
Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.
Member Services
If you have additional questions, call Member Services using the phone number on the back of your ID card.
Having technical problems?
Can’t log in? Page not loading? Things not working the way they should? We can help.
Technical Help
Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET
Questions that Require Phone Support
The following questions are best answered by one of our Member Services experts.
- Can you help me understand how my insurance plan works?
- How do I get assistance with complex benefits or specific benefit issues?
- How do I get more information about a particular treatment/service I’m considering?
- How do I find out if I need prior authorization for a procedure?
- What’s the status of my prior authorization request?
- How do I know how many visits I have remaining for a specific service (e.g., physical therapy)?
- How do I know how much money I have remaining in my allowance for a specific service (e.g., infertility treatments)?
Support & Service
Need help with your plan?
Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.
Member Services
If you have additional questions, call Member Services using the phone number on the back of your ID card
Having technical problems?
Can’t log in? Page not loading? Things not working the way they should? We can help.
Technical Help
Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET
Questions that require phone support
The following questions are best answered by one of our Member Services experts.
- What’s the status of my claim appeal?
- Can you explain the denial code on my benefits claim?
- Can you help me with a claim I think has been processed incorrectly?
- Why is my claim being adjusted?
- Why was my claim with my in-network doctor processed as out-of-network ?
- Can you help me figure out how much I owe and to whom?
- Can you help me update my Coordination of Benefits (COB)?
- Can you help me with a routine visit that requires applied a cost share/patient liability?
- What’s the status of my over-accumulation review?
Support & Service
Need help with your plan?
Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.
Member Services
If you have additional questions, call Member Services using the phone number on the back of your ID card.
Having technical problems?
Can’t log in? Page not loading? Things not working the way they should? We can help.
Technical Help
Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET
Questions that require phone support
The following questions are best answered by one of our Member Services experts.
- I can’t find a medical specialist for a specific issue. Can you help me?
- I can’t find a mental health specialist for a specific issue. Can you help me?
- Can you help me find an in-network doctor who doesn’t appear when using the Find a Doctor tool?
- Do I need prior authorization for a procedure I’m considering?
- Do I need a referral to see a specialist?
- Can you tell me if a doctor who’s not listed as a pediatrician works with children?
Support & Service
Need help with your plan?
Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.
Member Services
If you have additional questions, call Member Services using the phone number on the back of your ID card.
Having technical problems?
Can’t log in? Page not loading? Things not working the way they should? We can help.
Technical Help
Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET
Questions that require phone support
The following questions are best answered by one of our Member Services experts.
- How can my healthcare plan help me save money?
- Am I eligible for any non-medical discounts through CareFirst?
Support & Service
Need help with your plan?
Have a question about your benefits? Not finding your answer online? Something else? We’re here for you.
Member Services
If you have additional questions, call Member Services using the phone number on the back of your ID card.
Having technical problems?
Can’t log in? Page not loading? Things not working the way they should? We can help.
Technical Help
Phone: 877-526-8390
Hours: Monday–Friday, 8 a.m.–6 p.m. ET
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