As a control function, a provider should set up an account system. This can be used to evaluate satisfaction of end goals, such as effective maximization of third-party payments, and to assist in the satisfaction of means goals, such as efficient
completion of insurance claim forms. The child's financial account stored electronically and in paper form, might include:
- current policy details or requirements of third-party plans covering the child,
- postings from service logs to reflect summary details of frequency and type(s) of service,
- entries to reflect the sequence of claim submissions and the amounts funded by third-party payers
A properly implemented and maintained "related-service" financial account system can provide the necessary details to respond to individual family inquiries regarding the provider's access of their insurance plans.
As the explanation of benefits and funding are received, the provider will want to document the activity. The explanation of benefits reports the processing of the claim and the benefits payable to denied or applied to the deductible. It is important
to record claims activity (charges billed and results) by service category, date, site, and practitioner. It would also be important to be able to provide the family statement of an individual child's activity (charges billed by service category and
amount of funding).
In all instances when an insurance carrier has been billed for EI services, whether paid in full, paid in part, or denied by the carrier, the provider must provide the Central Billing Office, within 90 days after receipt, a copy of the explanation of
benefits and a copy of the claim with the data elements required by the EI-CBO. This information is used for the purpose of cost analysis and demographic data collection.