EOB Concierge Enrollment Form

Your employer may have chosen to enroll you in MaxMed105’s EOB CONCIERGE PROGRAM. Traditionally, a MaxMed105 member is required to send all insurance company’s Explanation of Benefits (EOB’s) to eba&m. With the EOB CONCIERGE PROGRAM this step will be done for you. To do this, eba&m will utilize the insurance company’s website to make a weekly sweep for each members’ EOB’s.

Access to the insurance company’s website is given to you, the member. To enroll in the EOB CONCIERGE PROGRAM, you will have to register online and then provide eba&m with your user name and password. DUE TO PRIVACY REGULATIONS, EACH MEMBER OF YOUR FAMILY OVER 18 YEARS OF AGE MUST CREATE THEIR OWN LOGIN.

To register, please go to your insurance company’s website. Follow their instructions to register as a user. After completing the registration, fill in your user name and password on this form. It is very important that you clearly indicate the correct user name and password, including upper and lower case letters.

Please keep in mind that it is your responsibility to provide us with your user name and password. If you fail to do so, or choose not to provide it to us, we cannot retrieve your EOB’s and it will be YOUR RESPONSIBILITY to send them in to eba&m! If for any reason your login information changes it is your responsibility to provide eba&m with the updated information. If your employer did not sign up for the EOB Concierge program, you must send in your EOB’s to eba&m Corporation for your claim to be processed.