Which statement about Explanation of Benefits (EOB) is correct?

• A. EOB shows patient responsibility and payment details.
• B. EOB is the official claim submission form.
• C. EOB lists only denied services.
• D. EOB is used to submit to payer for denial review.

Answer: (D)

An Explanation of Benefits shows how a claim was processed, including what the insurer paid, what was allowed, any adjustments, and what the patient still owes. This documentation becomes particularly useful when a service is denied and an appeal or denial review is needed. In that scenario, the EOB is included with the denial review package to illustrate exactly how the claim was processed and where the denial occurred, helping the payer reassess the decision. That is why this statement fits best: the EOB is used to submit to the payer for denial review, since it provides the payer with the processing details they need to reevaluate the claim. The other statements don’t capture this function as accurately: the EOB is not the official claim submission form; it lists payments and adjustments for all processed services, not only denied ones.