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Division Director

Tanner Holloman

Assistant Director

Andrew Sabolic


Workers' Compensation
200 East Gaines Street
Tallahassee, FL 32399-0318
Workers' Compensation Claims
(800) 342-1741
Workers' Compensation Exemption/ Compliance
(850) 413-1609

Division of Workers' Compensation

EOBR Frequently Asked Questions

Question: What is an EOBR?

Answer: An EOBR is an Explanation of Bill Review; it is the notice of payment or notice of adjustment, disallowance or denial sent by a carrier, service company/third party administrator or any entity acting on behalf of a carrier to a health care provider (provider) containing code(s) and code descriptor(s), in conformance with paragraph 69L-7.740(13), Florida Administrative Code.

 

Question: What is the purpose of the EOBR?

Answer: The EOBR is the carrier’s written official notification to the provider of the reimbursement decisions to pay, disallow or adjust reimbursement. The carrier is required to explain the reimbursement for each billed line item by using the EOBR codes (listed in Rule within subsection 69L-7.740(13)(b), F.A.C.) that best describe the carrier’s reimbursement decision.

 

Question: Is the term "Explanation of Bill Review" or acronym "EOBR" required to be on the form, verbatim or is the title optional?

Answer: The term "Explanation of Bill Review" is preferred by the Division, but it is not a requirement. If the document was titled something differently but still met the requirements of Rule 69L-7.740, Florida Administrative Code, if it was the document given to providers to convey the disposition decision, and the document was presented as the EOBR, the Division would accept it as such.

 

Question: May an EOBR contain unique, in-house EOBR Explanation Codes?

Answer: Yes. Each line item on an EOBR must contain at least one EOBR Code authorized in paragraph 69L-7.740(13)(a), Florida Administrative Code. All Rule authorized codes must be primary and superior to any other internal code. After this requirement has been fulfilled, internal and unique codes may be used and should be presented in a separate and distinct manner.

 

Question: Do EOBR codes and descriptors have to be placed on the EOBR ahead of carrier specific payment/denial explanations?

Answer: Yes. Each line item on an EOBR must contain at least one EOBR Code authorized in paragraph 69L-7.740(13)(b), Florida Administrative Code. All Rule authorized codes must be primary and superior to any other internal code. After this requirement has been fulfilled, internal and unique codes may be used and should be presented in a separate and distinct manner.

 

Question: Is it permissible to use a separate and distinct portion of the EOBR to provide unique codes and descriptions for reductions in addition to the state specific EOBR codes and descriptions?

Answer: Yes, as long as all other requirements under subsection 69L-7.740(14), Florida Administrative Code are met, it is permissible.

 

Question: Some of our clients request that we process bills according to the provider state where services are rendered rather the jurisdiction state. Do the Requirements in Rule 69L-7.740, Florida Administrative Code apply to this situation?

Answer: Yes. All bills that fall under Florida Workers' Compensation laws must comply with Rule 69L-7.740, Florida Administrative Code.

 

Question: What if a provider does not want an EOBR or a Florida specific EOBR?

Answer: An EOBR is still required. All bills that fall under Florida Workers' Compensation laws must be responded to in compliance with Rule 69L-7.740, Florida Administrative Code.

 

Question: What is a Carrier?

Answer: "Carrier" means any person or fund authorized under section 440.38, F.S. to insure under this chapter and includes a self-carrier, and a commercial self-insurance fund authorized under section 624.462, F.S.

 

Question: Is the actual carrier information required on an EOBR for the injured employee?

Answer: The actual carrier’s information for the injured employee’s claim is required on all EOBRs. Per subsection 69L-7.740(14), Florida Administrative Code, the specific carrier’s name, address, and Division issued carrier number is required on an EOBR.

 

Question: If a carrier has a claim administrator, should the claim administrator’s mailing address and Division issued number be used in place of the carrier’s information?

Answer: No. Per subsection 69L-7.740(14), Florida Administrative Code, the specific carrier's name, address, and Division issued carrier number are required on an EOBR. If the carrier has identified the claim administrator as the entity designated to receive service on behalf of the carrier and all affected parties for the purpose of receiving the petitioner’s service of a copy of a petition for reimbursement dispute resolution, the claim administrator’s name and mailing address must appear on the EOBR.

 

Question: Is an employer's name and address required on an EOBR?

Answer: No, please refer to subsection 69L-7.740(14), Florida Administrative Code.

 

Question: Should an EOBR reflect identifying information for the injured employee?

Answer: The DWC prefers identifying information for the injured employee on EOBRs.

 

Question: Is the carrier or claim administrator responsible for the conveyance of the EOBR?

Answer: The carrier is responsible for communicating its reimbursement decision to the provider. This is done via the EOBR. The carrier may delegate this duty to the claim administrator; however, the carrier continues to be ultimately responsible for ensuring that the EOBR is sent to the provider.

 

Question: Is an electronic version of the EOBR acceptable?

Answer: Yes. Whether or not a provider receives the EOBR in a paper or electronic format is up to the respective parties. However, if the parties agree that the electronic format will serve as the EOBR, that electronic format must include the same elements as a compliant EOBR, per subsection 69L-7.740(14), Florida Administrative Code. In addition, the EOBR must be legibly reproduced upon request.

 

Question: May an EOBR be used to respond to reconsideration requests?

Answer: An EOBR must be used if the reconsideration is in the form of a valid bill. If a reconsideration is not requested via a valid bill, an EOBR may be used.

 

Question: Are there guidelines for determining importance of EOBR Codes?

Answer: A carrier may use up to three (3) EOBR codes and descriptors per billed line item to explain a reimbursement decision. The EOBR codes should be listed in order from the carrier's most important reason to least important reason. This matter of importance is determined by the carrier or its designee. Please refer to paragraph 7.740(13)(a), Florida Administrative Code.

 

Question: Can the Division provide examples of valid EOBRs or a blank EOBR form?

Answer: The Division does not have a standard format for EOBRs. A carrier can select their own EOBR format as long as it meets all requirements found in Rule 69L-7.740, Florida Administrative Code.

 

Question: Must an EOBR state that it constitutes notice of disallowance or adjustment of payment within the meaning of section 440.13(7), F.S.? Where on the EOBR must this statement be placed?

Answer: Yes, please refer to paragraph 69L-7.740(14), Florida Administrative Code. The statement must appear on the EOBR; however, each carrier may choose the location of the statement.

 

Question: If there is a system limitation that does not allow for population of the 'parenthetical' requirements in the EOBR description, can the additional information be accounted for in separate, system-generated messages?

Answer: Yes. System limitations may be overcome via the use of common abbreviations and suffixes, as well as by cross-reference within the parenthetical to carrier unique code or index systems. A carrier unique code could be placed in the parentheses and the information could be conveyed elsewhere on the EOBR.

 

Question: What if one of the elements required for an EOBR cannot be possibly met due to database constrictions such as identifying and labeling the integral component or inclusive component in an EOBR description?

Answer: The EOBR would be non-compliant. If you have a concern about whether your EOBR is compliant, the Bureau of Monitoring and Audit is happy to review and comment on any entity's EOBR. Please contact Workers.CompMedService@myfloridacfo.com.

 

Question: If the carrier needs to add a note along with the state EOBR code, can the note have a code associated with it?

Answer: Yes, as long as the EOBR meets all other requirements. All rule authorized codes must be primary and superior to any internal code. After this requirement has been fulfilled, internal and unique codes may be used and should be presented in a separate and distinct manner.

 

Question: If a bill was subject to PPO network reductions and the appropriate EOBR code was used at the line level, is it appropriate to exclude the parenthetical stating the PPO network name from that EOBR code as long as there is a distinct place (box) on the form that indicates the PPO name, address, information?

Answer: If the PPO's name was explicitly indicated as such, it would meet the requirements.