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 |