Explanations of Payment
Explanations of Payment (EOPs) are statements of the current status of your claims that have been submitted to CareSource and entered into our system. EOPs are usually generated every week. However, you may not receive an EOP each time they are generated depending on your claims activity.
EOPs include paid and denied claims. Any denied claims appear on the EOP with a message code indicating the reason the claim is unpaid. Providers can resubmit denied claims, as appropriate, with the corrected or completed information needed for processing. Please click on the Explanation of Payment (EOP) Sample, to see the format of CareSource’s EOP.
Pended Claims
Providers also receive a separate explanation of pended claims each month. Pended claims have not been denied. These are claims that have been entered into our system, but due to timing issues, have not yet been processed completely. We notify you of pended claims merely to acknowledge receipt.
Please wait for pended claims to appear on a future EOP as paid or denied before taking any needed action. Do not resubmit pended claims. This may delay processing.