S.F. 2143 Section 1. EXPLANATION OF BENEFITS —— MEDICAL ASSISTANCE 1 PROGRAM. The department of human services shall develop and 2 utilize an explanation of benefits to be provided to recipients 3 of the medical assistance program. The purposes of providing 4 the explanation of benefits are to inform recipients of the 5 medical assistance program services for which the department 6 is billed on their behalf, to assist the department in 7 tracking any services incorrectly recorded or not received, 8 and to provide the department with a mechanism of identifying 9 providers, provider groups, and geographic areas for evaluation 10 of care and treatment patterns. The explanation of benefits 11 shall at a minimum provide a recipient with information 12 including the name of the provider, type of service, date of 13 service, and amount paid by the medical assistance program. 14 The explanation of benefits shall also provide a means for the 15 recipient to contact the department regarding any errors in the 16 explanation of benefits. 17 EXPLANATION 18 This bill directs the department of human services (DHS) 19 to develop and utilize explanations of benefits (EOB) to be 20 provided to recipients of the medical assistance program. The 21 bill provides that the purposes of the EOBs are to inform 22 recipients of the Medicaid programs services for which DHS 23 is billed on their behalf, to assist DHS in tracking any 24 services incorrectly recorded or not received, and to provide 25 DHS with a mechanism to identify providers, provider groups, 26 and geographic areas for evaluation of care and treatment 27 patterns. The EOBs are to include, at a minimum, the name of 28 the provider, type of service, date of service, and amount paid 29 by the Medicaid program. The EOB is also to provide a means for 30 the recipient to contact DHS regarding any errors in the EOB. 31 -1- LSB 6053XS (2) 83 pf/nh 1/ 1