| Prompt |
Response |
Req |
Len |
| From Patient |
Type the patient account number you
want to begin with, or leave the field blank to start with the
first account number in the system. |
|
10 |
| Through Patient |
Type the patient account number you
want to end with, or leave the field blank to end with the last
account number in the system. |
|
10 |
| From Performing Dr |
Type the code you want to begin with,
click the magnifying glass to search the table, or leave the field
blank to start with the first code in the table. |
|
4 |
| Through Performing Dr |
Type the code you want to end with,
click the magnifying glass to search the table, or leave the field
blank to end with the last code in the table. |
|
4 |
| From Location |
Type the code you want to begin with,
click the magnifying glass to search the table, or leave the field
blank to start with the first code in the table. |
|
10 |
| Through Location |
Type the code you want to end with,
click the magnifying glass to search the table, or leave the field
blank to end with the last code in the table. |
|
10 |
| From Procedure Code |
Type the procedure code you want to
begin with, or leave the field blank to start with the first code
in the table. The field allows up to five characters and does
not provide the magnifying glass table search feature, in order
to allow you to include procedure codes with modifiers. For example,
if you type 99999 in From Procedure Code and 99999
in Through Procedure Code, the report contains all procedure
codes that start with 99999, including codes that have modifiers
(99999, 9999950, 99999LT, etc.). |
|
5 |
| Through Procedure Code |
Type the procedure code you want to
end with, or leave the field blank to end with the last code in
the table. |
|
5 |
| From Date |
Type the date you want the report to
begin with or click the calendar icon to select a date. |
|
10 |
| Through Date |
Type the date you want the report to
end with or click the calendar icon to select a date. |
|
10 |
| From Diagnosis Code |
Type the diagnosis code you want to
begin with, click the magnifying glass to search the table, or
leave the field blank to start with the first diagnosis code in
the table. |
|
|
| Through Diagnosis Code |
Type the diagnosis code you want to
end with, click the magnifying glass to search the table, or leave
the field blank to end with the last diagnosis code in the table. |
|
|
| Billing Group |
Type the billing group code you want
or click the magnifying glass to search the table to limit the
report to a specific billing group. |
|
|
| Print By |
Select Accounting Date to gather
data based on the accounting date of each transaction, or select
Service Date to gather data based on the date of service. |
 |
1 |
| Include Negated Charges |
If you want the report to include negated
charges, select this check box. |
|
1 |
| Data Element |
Code |
| Adj-Acct Date | J9.0 |
| Adj-Actual Date Posted | J9.0e |
| Adj-Amount $ | J9.3 |
| Adj-Amt Posted to Adjusted Transaction | J9.12 |
| Adj-Code | J9.2 |
| Adj-Code Desc | J9.2a |
| Adj-DOS of Adjusted Transaction | J9.13 |
| Adj-Proc Code of Adjusted Transaction | J9.11 |
| Adj-Timestamp Posted | J9.0t |
| Adj-User Code | J9.0u |
| Billing Account Description | B1.4 |
| Billing Alert User | B1.2 |
| Billing Benefits Assignment | B1.5 |
| Billing Employer's Address Line 1 | B1.13 |
| Billing Employer's Address Line 2 | B1.27 |
| Billing Employer's City | B1.23 |
| Billing Employer's State | B1.24 |
| Billing Employer's Telephone Number | B1.15 |
| Billing Employer's Zip Code | B1.22 |
| Billing Employment Status | B1.19 |
| Billing Erase Statement Comment | B1.18 |
| Billing Fee Schedule (Alternate Fee) | B1.11 |
| Billing Finance Charges | B1.16 |
| Billing Group Code | B1.1 |
| Billing Group Description | B1.1d |
| Billing Guarantor's Employer | B1.12 |
| Billing Internal Comment | B1.8 |
| Billing Medicare Patient | B1.10 |
| Billing Print Aging Message | B1.17 |
| Billing Release of Information | B1.28 |
| Billing Report Comment | B1.7 |
| Billing Send Statement | B1.3 |
| Billing Statement Comment | B1.6 |
| Billing Suppress Collections | B1.21 |
| Billing Use Primary Address | B1.9 |
| Database Number | D0 |
| Encounter DX Codes | E1.1 |
| Encounter DX Descriptions | E1.2 |
| Guarantor Address Line 1 | G1.4 |
| Guarantor Address Line 2 | G1.5 |
| Guarantor Birth Date | G1.18 |
| Guarantor City | G1.6 |
| Guarantor Country Code | G1.19 |
| Guarantor County | G1.20 |
| Guarantor E-Mail Address | G1.17 |
| Guarantor First Name | G1.2 |
| Guarantor Last Name | G1.1 |
| Guarantor Middle Initial | G1.3 |
| Guarantor Middle Name | G1.26 |
| Guarantor Phone Cell | G1.24 |
| Guarantor Phone Home | G1.9 |
| Guarantor Phone Secondary | G1.16 |
| Guarantor Secondary Address Line 1 | G1.11 |
| Guarantor Secondary Address Line 2 | G1.12 |
| Guarantor Secondary City | G1.13 |
| Guarantor Secondary Country Code | G1.21 |
| Guarantor Secondary County | G1.22 |
| Guarantor Secondary State | G1.14 |
| Guarantor Secondary Subdivision | G1.29 |
| Guarantor Secondary Zip Code | G1.15 |
| Guarantor Social Security # | G1.10 |
| Guarantor State Code | G1.7 |
| Guarantor Subdivision | G1.30 |
| Guarantor Suffix | G1.27 |
| Guarantor Zip Code | G1.8 |
| Patient Account Number | P1.0 |
| Patient Address Line 1 | P1.4 |
| Patient Address Line 2 | P1.5 |
| Patient Age | P1.13a |
| Patient Balance | P8.4 |
| Patient Birth Date | P1.13 |
| Patient Cell Phone | P1.24 |
| Patient City | P1.6 |
| Patient Class Codes | P1.22 |
| Patient Class Description | P1.22d |
| Patient Country Code | P1.30 |
| Patient County Code | P1.31 |
| Patient Date Account Last Reviewed | P1.44 |
| Patient Date of Death | P1.37 |
| Patient Date of First Visit | P1.17 |
| Patient Default DX | P1.11 |
| Patient Default Location Code | P1.18 |
| Patient Default Location Description | P1.18d |
| Patient Email | P1.23 |
| Patient Ethnicity Code | P1.33 |
| Patient Ethnicity Code - Description | P1.33d |
| Patient First Name | P1.2 |
| Patient Firstname Lastname | P1.1b |
| Patient Gender Identity | P1.42 |
| Patient Gender Identity Description | P1.42d |
| Patient Gender Identity Other | P1.43 |
| Patient Home Phone | P1.9 |
| Patient Identifier | P1.29 |
| Patient Language | P1.27 |
| Patient Last Name | P1.1 |
| Patient Last Payment Amount | P8.2 |
| Patient Last Payment Date | P8.1 |
| Patient Last Statement Date | P8.3 |
| Patient Lastname, Firstname | P1.1a |
| Patient Middle Initial | P1.3 |
| Patient Primary Doctor | P1.19 |
| Patient Primary Doctor Description | P1.19d |
| Patient Race | P1.28 |
| Patient Race Description | P1.28d |
| Patient Race Other | P1.34 |
| Patient Race Other Description | P1.34d |
| Patient Referral Code | P1.15 |
| Patient Referral First Name | P1.15c |
| Patient Referral Last Name | P1.15b |
| Patient Referral Middle Initial | P1.15d |
| Patient Referral Printing Name | P1.15a |
| Patient Referral Suffix | P1.15e |
| Patient Referral Type | P1.32 |
| Patient Rel to Guarantor | P1.14 |
| Patient Rel to Guarantor Description | P1.14d |
| Patient Responsible Doctor | P1.16 |
| Patient Responsible Doctor Description | P1.16d |
| Patient Sex | P1.12 |
| Patient Sex Description | P1.12d |
| Patient Sex Orientation | P1.40 |
| Patient Sex Orientation Description | P1.40d |
| Patient Sex Orientation Other | P1.41 |
| Patient Social Security # | P1.10 |
| Patient State | P1.7 |
| Patient Status | P1.20 |
| Patient Status Description | P1.20d |
| Patient Subdivision | P1.38 |
| Patient Suffix | P1.36 |
| Patient Zip | P1.8 |
| Pmt-Acct Date | C9.0 |
| Pmt-Actual Date Posted | C9.0e |
| Pmt-Amount $ | C9.3 |
| Pmt-Amt Posted to Paid Transaction $ | C9.12 |
| Pmt-Code | C9.2 |
| Pmt-Code Desc | C9.2a |
| Pmt-DOS of Paid Transaction | C9.14 |
| Pmt-ICN | C9.0i |
| Pmt-Ins Carrier Code | C9.15 |
| Pmt-Ins Carrier Desc | C9.15a |
| Pmt-Patient | C9.15e |
| Pmt-Posted Allowed Amt $ | C9.13 |
| Pmt-Primary Carrier | C9.15b |
| Pmt-Proc Code of Paid Transaction | C9.11 |
| Pmt-Secondary Carrier | C9.15c |
| Pmt-Tertiary Carrier | C9.15d |
| Pmt-Timestamp Posted | C9.0t |
| Pmt-User Code | C9.0u |
| Primary Carrier Allowed Amount | T9.76 |
| Primary Carrier Auth Required | I1.01 |
| Primary Carrier Code | I1.1 |
| Primary Carrier Copay | I1.16 |
| Primary Carrier Group Number | I1.5 |
| Primary Carrier Last Verified By | I1.34 |
| Primary Carrier Last Verified Date | I1.33 |
| Primary Carrier Name | I1.0 |
| Primary Carrier Plan Code | I1.14 |
| Primary Carrier Plan Code Desc | I1.14a |
| Primary Carrier Policy Number | I1.6 |
| Primary Carrier Spec Copay | I1.24 |
| Primary Carrier Verified By via CGM webVERIFY | I1.29 |
| Primary Carrier Verified Date via CGM webVERIFY | I1.28 |
| Proc-Accept Assignment | T9.21 |
| Proc-Actual Date Posted | T9.0e |
| Proc-All Modifiers | T9.20 |
| Proc-Batch # | T9.32 |
| Proc-Billing Group Code | T9.35 |
| Proc-Billing Group Desc | T9.35a |
| Proc-Case # | T9.28 |
| Proc-Charge Amount $ | T9.3 |
| Proc-Chg Acct Date | T9.0 |
| Proc-CPT Code | T9.2 |
| Proc-CPT Desc | T9.2a |
| Proc-CPT Total Units (Units x QTY) | T9.2c |
| Proc-CPT Units per CPT | T9.2b |
| Proc-Date of Ill/Inj/Lmp | T9.28a |
| Proc-Date of Service | T9.10 |
| Proc-Delinquent Flag | T9.18 |
| Proc-Department Code | T9.36 |
| Proc-Department Desc | T9.36a |
| Proc-DX 1 | T9.72 |
| Proc-DX 1 Description | T9.72a |
| Proc-DX 2 | T9.73 |
| Proc-DX 2 Description | T9.73a |
| Proc-DX 3 | T9.74 |
| Proc-DX 3 Description | T9.74a |
| Proc-DX 4 | T9.75 |
| Proc-DX 4 Desc | T9.75a |
| Proc-Encounter # | T9.64 |
| Proc-EncounterProcID | T9.64a |
| Proc-Fee Schedule Allowed Amt $ | T9.24 |
| Proc-Ins Balance | T9.26 |
| Proc-Ins Doctor Code | T9.31 |
| Proc-Ins Doctor Name | T9.31a |
| Proc-Ins Last Refiled/Denied Date | T9.15 |
| Proc-Ins Last Refiled/Denied Reason | T9.16 |
| Proc-Ins Responsible Carrier Code | T9.14a |
| Proc-Ins Responsible Carrier Description | T9.14ab |
| Proc-Ins Responsible Carrier Last File Amount | T9.14e |
| Proc-Ins Responsible Carrier Last Filing Date | T9.14c |
| Proc-Ins Responsible Carrier Original Filing Date | T9.14d |
| Proc-Ins Responsible Carrier Type | T9.14b |
| Proc-Ins Status | T9.14 |
| Proc-Last Pmt ICN | T9.99j |
| Proc-Last Pmt ICN Amount $ | T9.99k |
| Proc-Location Code | T9.11 |
| Proc-Location Desc | T9.11a |
| Proc-Master Account | T9.0m |
| Proc-MED Allowable Amount $ | T9.99a |
| Proc-Modifier 1 | T9.20a |
| Proc-Modifier 2 | T9.20b |
| Proc-Modifier 3 | T9.20c |
| Proc-Modifier 4 | T9.20d |
| Proc-Patient Acct Number | T9.12 |
| Proc-Patient Name | T9.22 |
| Proc-Performing Dr Code | T9.5 |
| Proc-Performing Dr Name | T9.5a |
| Proc-Performing Dr NPI | T9.5b |
| Proc-Place of Service Code BCBS | T9.11e |
| Proc-Place of Service Code DMERC | T9.11d |
| Proc-Place of Service Code HCFA | T9.11b |
| Proc-Place of Service Code MEDICAID | T9.11f |
| Proc-Place of Service Code MEDICARE | T9.11c |
| Proc-Pmt Acct Date | T9.0d |
| Proc-Pt Balance | T9.25 |
| Proc-Quantity | T9.17 |
| Proc-RBRVS Fac Malpractice | T9.99f |
| Proc-RBRVS Fac Practice | T9.99g |
| Proc-RBRVS Fac Total | T9.99h |
| Proc-RBRVS Fac Work | T9.99i |
| Proc-RBRVS Non Fac Malpractice | T9.99b |
| Proc-RBRVS Non Fac Practice | T9.99c |
| Proc-RBRVS Non Fac Total | T9.99d |
| Proc-RBRVS Non Fac Work | T9.99e |
| Proc-Referring Dr Code | T9.23 |
| Proc-Referring Dr Name | T9.23a |
| Proc-Remarks | T9.4 |
| Proc-Superbill | T9.19 |
| Proc-Timestamp Posted | T9.0t |
| Proc-Total Adjustments $ | T9.0a |
| Proc-Total Bal $ | T9.13 |
| Proc-Total Payments $ | T9.0p |
| Proc-Type of Service | T9.2d |
| Proc-Type of Service Desc | T9.2da |
| Proc-User Code | T9.45 |
| Secondary Carrier Allowed Amount | T9.77 |
| Secondary Carrier Auth Required | I2.01 |
| Secondary Carrier Code | I2.1 |
| Secondary Carrier Copay | I2.16 |
| Secondary Carrier Group Number | I2.5 |
| Secondary Carrier Last Verified By | I2.34 |
| Secondary Carrier Last Verified Date | I2.33 |
| Secondary Carrier Name | I2.0 |
| Secondary Carrier Plan Code | I2.14 |
| Secondary Carrier Plan Code Desc | I2.14a |
| Secondary Carrier Policy Number | I2.6 |
| Secondary Carrier Spec Copay | I2.24 |
| Secondary Carrier Verified By via CGM webVERIFY | I2.29 |
| Secondary Carrier Verified Date via CGM webVERIFY | I2.28 |
| Tertiary Carrier Auth Required | I3.01 |
| Tertiary Carrier Code | I3.1 |
| Tertiary Carrier Copay | I3.16 |
| Tertiary Carrier Group Number | I3.5 |
| Tertiary Carrier Last Verified By | I3.34 |
| Tertiary Carrier Last Verified Date | I3.33 |
| Tertiary Carrier Name | I3.0 |
| Tertiary Carrier Plan Code | I3.14 |
| Tertiary Carrier Plan Code Desc | I3.14a |
| Tertiary Carrier Policy Number | I3.6 |
| Tertiary Carrier Spec Copay | I3.24 |
| Tertiary Carrier Verified By via CGM webVERIFY | I3.29 |
| Tertiary Carrier Verified Date via CGM webVERIFY | I3.28 |