Prompt | Response | Req | Len |
---|---|---|---|
Procedure Code | Type the code you want or click the magnifying glass to search the table. | 8 | |
Modifier | Type the modifier. | 6 | |
Amount $ | This field is informational only and reflects the charge amount. | 15 | |
Allowed Amt $ | Type the allowed amount. | 10 | |
Alt. Desc. | Type an alternate description of the procedure code. | 40 | |
Per Dr | Type the code you want or select from the Doctor list. | 3 | |
Diag 1 | Type the code you want or click the magnifying glass to search the table. | 10 | |
Diag 2 | Type the code you want or click the magnifying glass to search the table. | 10 | |
Diag 3 | Type the code you want or click the magnifying glass to search the table. | 10 | |
Diag 4 | Type the code you want or click the magnifying glass to search the table. | 10 | |
Service Date | Type the date you want or click the calendar icon to select a date. | 10 | |
Claim Hold | Type the date you want or click the calendar icon to select a date. | 10 | |
Location Code | Type the code you want or select from the Location list. | 3 | |
Department Code | Type the code you want or select from the Department list. | 3 | |
Multiplier | Type a multiplier number greater than zero. | 4 | |
Billing Group | Type the code you want or click the magnifying glass to search the table. | 3 | |
Accept Assignment | If you want to modify the assignment status, select or clear this check box. | 1 | |
Date of Ill/Inj | Type the date you want or click the calendar icon to select a date. | 10 | |
Superbill Number | Type the superbill number. | 10 | |
Service Script | Select a date from the Service Script list. | 10 | |
Referral Source | Type the code you want or click the magnifying glass to search the table. | 6 | |
Case Record | Type the code you want or select from the Case Record list. | 3 | |
Ins Dr | Type the code you want or select from the Doctor list. | 5 | |
Ins Dr Taxonomy | Type the batch number you want or click the magnifying glass to search the table. | 40 | |
Sup Dr | 40 | ||
Batch Number | Type the batch number you want or click the magnifying glass to search the table. | 20 | |
Coinsurance $ | If this charge was not paid for because of coinsurance then you must enter the amount that went toward the coinsurance in this field. | 10 | |
Other $ | Type the date you want or click the calendar icon to select a date. | 10 | |
Deductible $ | If a portion or all of this line item went toward the deductible amount, then put the dollar amount that went to deductible. | 10 | |
Other Code | Select a date from the Service Script list. | 3 | |
Copay $ | If this charge was not paid for because of copay then you must enter the amount that went toward the copay in this field. | 10 | |
Editing Reason | Type the date you want or click the calendar icon to select a date. | 40 | |
Edit All Charges for this Accounting Date | If you want to edit all charges for this accounting date, select this check box. | 1 |
Prompt | Response | Req | Len |
---|---|---|---|
Payment Code | This field is informational only and reflects the Payment Code. | 5 | |
Amount $ | This field is informational only and reflects the payment amount. | 15 | |
Remarks | Type any remarks you want. | 40 | |
Payment Date | Type the date you want or click the calendar icon to select a date. | 10 | |
Batch Number | Type the batch number. | 17 | |
Check Number | Type the check number. | 20 | |
ICN Number | Type the ICN number. | 20 |
Prompt | Response | Req | Len |
---|---|---|---|
Patient Number | This field is informational only and reflects the account number. | 5 | |
Patient Name | This field is informational only and reflects the patient's name. | 15 | |
Adjustment Code | This field is informational only and reflects the Adjustment Code. | 5 | |
Amount $ | This field is informational only and reflects the adjustment amount. | 15 | |
Remarks | Type any remarks you want. | 40 | |
Adjustment Date | Type the date you want or click the calendar icon to select a date. | 10 | |
Batch Number | Type the batch number. | 17 |