EOR —
Explanation of Review.
The written explanation a workers’-comp payer sends with (or instead of) a check, saying what it paid on each line of your bill and why. It is the document that tells you a bill was short-paid.
The remittance, with reasons attached.
An Explanation of Review is workers’ compensation’s version of the EOB you may know from group health. The payer — an MCO, a carrier, a TPA, a state fund — lists the bill it processed, what it allowed, what it paid, and a reason code for any difference.
It usually arrives alongside a check that covers several claimants at once, which is why an EOR is rarely read line by line. The total on the check matches the total on the EOR, so everything looks reconciled. What it does not tell you, unless you look, is whether the total on the EOR matches what you actually billed.
It is where a short-pay is visible, and nowhere else.
A denial announces itself. A short-pay does not: the line is paid, just for less than you billed, and the difference is often small enough to read as rounding. Sixteen dollars on line eleven. Eight dollars on line three.
The only way to see it is to compare the EOR line to the billed line — not the EOR total to the check. Do that across a year of remittances and the pattern is usually one of three things: a rate applied from the wrong schedule year, units converted wrongly (see unit), or a service the payer decided was outside the authorization.
Keep the EOR. When you rebill, the EOR and the original bill are the argument.
Related pages.
The short-pay calculator does the line-by-line arithmetic for one remittance in your browser, and short-pay recovery is what doing it automatically, on every check, looks like.
See your own week run itself.
We load your state’s codes before the call, so you are looking at a caseload like yours inside the first two minutes — not a slide deck.