| Service | Code | Billed | Allowed | Plan paid | You may owe | Remark |
|---|---|---|---|---|---|---|
| Office visit | 99214 | 240.00 | 132.40 | 107.40 | 25.00 | CO-45 PR-3 |
| Metabolic panel | 80053 | 88.00 | 21.60 | 21.60 | 0.00 | CO-45 |
| Blood draw | 36415 | 24.00 | 0.00 | 0.00 | 0.00 | CO-97 |
| Totals | Totals | 352.00 | 154.00 | 129.00 | 25.00 |
An EOB is not a bill. It's data.
What the plan paid and what the member may owe, line by line, typed for your agent.
An EOB reads like a bill, and it isn't one. It is what the bill gets checked against. Now an agent can check it.
The statement that explains the claim.
After a plan processes a claim, it reports the outcome line by line: billed, allowed, plan paid and what the member may owe.
Not a bill
The provider sends the bill. The EOB is how you check it.
Who gets it
The member gets the EOB. The provider gets it as an X12 835.
Remark codes
A standard code on every reduction, explaining why.
Appeal window
At least 180 days for most plans, from the decision notice.
Register
A health document, not P&C, typed like the loss run.
One statement, fourteen typed fields.
The shape an EOB resolves to, from a member PDF or an 835. Free, with no key.
example.jsonTypeMeaningSource
{"payer": "Cascade Health Plan",stringThe health plan that processed the claim.Plan
"member_id": "CHP-88214307",stringThe member it was processed for.Plan
"claim_number": "2026-183350021",stringThe plan's claim ID. Appeals cite it.Plan
"provider": "Lakeview Family Medicine",stringWho rendered and billed the services.Provider bill
"date_processed": "2026-06-24",dateWhen the plan finished processing.Plan
"lines": [3 itemsOne entry each; the first is shown in full.
{"date_of_service": "2026-06-02",dateWhen the service was rendered.Provider bill
"procedure_code": "99214",stringCPT or HCPCS code.Provider bill
"description": "Office visit",stringPlain-language service description.
"billed": 240,moneyWhat the provider charged.Provider bill
"allowed": 132.4,moneyThe plan's contracted rate, not the sticker price.Plan
"plan_paid": 107.4,moneyWhat the plan paid on the line.Plan
"patient_responsibility": 25,moneyCopay, coinsurance or deductible the member may owe.Plan
"remark_codes": ["CO-45", "PR-3"]string[]CARC and RARC codes for every reduction.Plan
},{ … }2 more, the same shape.
],"totals": { "billed": 352, "allowed": 154, "plan_paid": 129, "patient_responsibility": 25 },objectSums across the lines.Derived
"appeal_window": { "days": 180 }objectThe appeal deadline, when the EOB states it.Plan
}
The complete record is at /example.json, and its JSON Schema at /schema.json.
What your agent does with it
Three run keyless today. Parsing takes an access key.
Read the statement
A PDF or 835 remittance in, typed service lines out.
POST /parseaccess keyCheck the bill
The provider's bill against what the EOB says is owed.
reconcile_eob_billkeylessDecode remark codes
CO-45, PR-3 and the rest, in plain words a member can use.
explain_remark_codekeylessDraft the appeal
A letter for a line the plan didn't cover, for a person to send.
draft_eob_appealkeylessHand it to your agent
Point your agent at the MCP server. Remark codes, the bill check and the appeal draft become tools.
mcp.json
{ "mcpServers": { "eobs.claims": { "url": "https://eobs.claims/mcp" } }}
Tools · keyless
get_eob_schemaget_eob_exampleexplain_eob_fieldvalidate_eobexplain_remark_codereconcile_eob_billdraft_eob_appeal
Agent sessioneobs.claims/mcp
- callexplain_remark_code CO-97
- okbundled into another service · the member does not owe it
- callreconcile_eob_bill claim 2026-183350021, bill of 65.00
- okmay owe 25.00 · billed 65.00 · 40.00 above the EOB
- agentThe bill is 40.00 above what the plan says J. Rivera owes. Flagging it before anything is paid.
Questions
The short answers.
Is an EOB a bill?
No. It is the plan's statement after it processes a claim. Any bill comes from the provider; the EOB is what you check it against.
What is the allowed amount?
The plan's contracted rate for the service. Plan paid plus the member's share normally adds up to it.
What do codes like CO-45 mean?
CO is a contractual write-off the member doesn't owe; PR is the member's share. CO-45 is a charge above the fee schedule, CO-97 a bundled service, PR-3 a copay.
How long do I have to appeal?
At least 180 days for most plans, from the notice of the decision. The plan's own notice states the deadline that applies.
Check every bill against its EOB.
Request an access key for parsing statements.