Payer Reports and Responses

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Payers return several kinds of reports to provide details about a claims status and payment. These reports include the "Insurance Response" (ANSI 277) and "Electronic EOB" (ANSI 835).

Insurance Response

The Insurance Response is sent back to the provider to indicate whether or not the claim has been accepted for further processing. Acceptance does not guarantee a claim will be paid. A rejected claim needs to be revised and resubmitted to the Payer. A rejected response will have the reason for the rejection listed on the report.

Electronic EOB

The Electronic EOB provides details for a check or EFT received by the provider. This will detail the payment of the claim and any adjustments including contractual obligations, patient responsibility, etc. The Electronic EOB is available in both human and machine readable formats.

Human readable Electronic EOBs are delivered in PDF format. Machine readable EOBs are delivered in ANSI 835 format and are most commonly used to auto post payment details back to your software.

Apex EDI OneTouch API Methods for Reports

  • GetUnviewedFiles - Returns a list of Insurance Response and Electronic EOB files available for download. All files are in human readable formats.
  • GetUnviewedERAMFiles - Returns a list of unread Electronic EOBs in machine readable (ASNI 835) format.
  • GetFileByName - Downloads the requested file using the name retrieved from GetUnviewedFiles or GetUnviewedERAMFiles call.
  • MarkFileAsViewed - Mark a file as viewed after downloading it.