| Prompt |
Response |
Req |
Len |
| From Electronic Form |
Select the electronic form number you
want to start with or leave the field blank to begin with the
first code. |
|
2 |
| Through Electronic Form |
Select the electronic form number you
want to end with or leave the field blank to end with the last
code. |
|
2 |
| Begin with Date |
Type the date you want to begin with
or click the calendar icon to select a date. This date refers
to the date the insurance claim file was created.This date refers
to the date the insurance claim file was created. |
|
10 |
| End with Date |
Type the date you want to end with or
click the calendar icon to select a date. This date refers to
the date the insurance claim file was created. |
|
10 |
| Alpha or Numeric |
Select the option to print the patients
in alphabetical order by last name or in numeric order by account
number. |
 |
1 |
| Page Between Carrier |
If you want each carrier to begin printing
on a new page, select this check box. |
|
1 |
| Print Patient Total |
If you want to print a total claim dollar
amount for each patient, select this check box. |
|
1 |