Clarification on EOB Retrieve

Many members have asked to better understand Nonstop’s substantiation process: its purpose, how we safeguard personal health information, and how EOB Retrieve fits in the mix.

First and foremost, the substantiation process is intended to ensure that Nonstop’s accounting of the charges applied to an member's out-of-pocket tracking match the carrier’s. This essentially means that we need to make sure that any charges on the member's Nonstop Visa card are 1) in-network and covered by the carrier; and 2) have been applied to their deductible on the carrier's end. This ensures that the member get the full benefit of the Nonstop Wellness plan.  

It’s important to note that we focus on dates, dollars, and providers. We do not review, consider or have access to information about the types services provided or prescriptions. Nonstop does not approve or deny services. We merely confirm that: the carrier considered the service or prescription as in-network; that the date of services was in the plan year; and that the amount the carrier applied to ‘member responsibility’ (e.g. applied to the member deductible) matches the charge.  It's the carrier that determines what is covered by the plan itself, what is in-network versus out-of-network, and how much of the expense they reimburse and apply to the member responsibility.   

Carriers do not directly share claims data with Nonstop for employers, such as yours, with fewer than 1,000 employees.  As such, we need to get the information (e.g., service date, provider, amount, in/out network) from the member. There are two methods for doing this:

1. The member sends us Explanation of Benefits (EOB) via mail, email, or fax
2. The member signs up for EOB Retrieve, which automatically downloads the EOB.

We encourage the use of EOB Retrieve as it minimizes (or eliminates) the paperwork that our members need to do to substantiate their claims.  

Some key points regarding EOB Retrieve: 

1. It only pulls the date, provider name, and amount.  It does NOT detail the type of service or prescription, or allow Nonstop to log into a member's carrier account.  In other words, there’s no Personal Health Information (PHI) on the information we receive from EOB Retrieve and we cannot access a member's PHI.
2. We do not have access to a member's password.  This is obfuscated from our view and is stored in an encrypted form.   Members control it.
3. The data, even though it doesn’t contain PHI, is treated as if it were PHI. It’s accessed via secure connection, stored in a secure data center, and is only accessible by authorized personnel on our team.
4. Further, Nonstop is a named “Business Associate” of your organization.  This means that we have signed a contract that obligates us to safeguard the privacy and security of your employees data, both PHI and otherwise.  

We hope this information helps put you and your employees at ease, and we invite you to please share this with your staff. We remain available if you have any additional questions at 877.626.6057