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Knowledge Center

Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

December 9, 2014

Payments and remittance information can be received in a variety of formats, but still need to go through the reassociation process. Payments can be received via paper check or EFT, remittance advices can be received as a paper EOB, or as an electronic 835 file. This paper will address the reassociation process of all the formats, with an emphasis on electronic formats, and on non-zero payments. With zero payments, there is usually no check or EFT, but there will be a remittance advice that is important to receive and post. It is important to note that in order to further administrative simplification, electronic formats of both transactions are preferred whenever possible. While the primary audience for this paper is the Provider, there is payer impact as well, which is also included.

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