Claim Data

Claim Data

Claim Data holds all information related to claims within a customer's account. 

 Name Description
Claim IDDisplays the unique identifier of a particular claim.
Facility IDDisplays the unique identifier of the facility associated with a claim. If no facility is associated with the claim, this field will display 0.
Office IDDisplays the unique identifier of the office location associated with the claim. If no office location is associated with the claim, this field will display 0.
Patient IDDisplays the account number of the patient associated with a claim.
Practice IDDisplays the unique identifier of the practice associated with a claim
Referring Provider IDDisplays the unique identifier of the referring provider associated with a claim.
Rendering Provider IDDisplays the unique identifier of the rendering provider associated with a claim. 
Current Payer PriorityDisplays the priority of the current payer on the claim. This  means:

  • If the current payer is the primary payer, this field will display "Primary".
  • If the current payer is the secondary payer, this field will display "Secondary".
  • If the current payer is the tertiary payer, this field will display "Tertiary".
  • If the claim is not currently at a payer, this field will display 'None".
Deleted?Displays "Yes" if the claim has been marked as deleted. Displays "No" otherwise. It's best practice to use this as a static filter set to "No" to ensure deleted claims are not displaying on reports.
Has Facility?Displays "Yes" if the claim has a Facility associated with it. Displays "No" otherwise. This can be useful as a filter to only show claims that are associated with a Facility.
Has Referring?Displays "Yes" if the claim has a Referring Provider associated with hit. Displays "No" otherwise. This can be useful as a filter to only show claims that are associated with a Referring Provider.
ICD ListDisplays a list of all the claim's ICD codes, one after another.
Incomplete?Displays "Yes" if the claim "Incomplete" option is selected on the claim. Displays "No" otherwise.
Reference #Displays the data entered in the Reference # field on the claim, if applicable.
TypeDisplays this claim's type, which can be one of the following:

  • Professional
  • Institutional
UsernameDisplays the username of the user that last created/altered the claim.
Date EnteredDisplays the date that this claim was entered into the application.
Followup DateDisplays the Followup Date of the claim.
From DateDisplays the From Date of the claim.
Set to Status DueDisplays the date that this claim's status was last updated.
To DateDisplays the To Date of the claim.
Amount PaidDisplays the total amount that has been paid on this claim.
BalanceDisplays the total amount of this claim that is still outstanding.
Total AmountDisplays the original total amount of charges on the claim. 


Institutional - Diagnosis Codes


 Name Description
Admit CodeDisplays the chosen code in the "Admit" selection field.
Admit Code DescriptionDisplays an abbreviated description of the chosen code in the "Admit" selection field.
Diagnosis Code 2Displays the chosen code in the 1st "Other" selection field.
Diagnosis Code 2 DescriptionDisplays an abbreviated description of the chosen code in the 1st "Other" selection field.
Diagnosis Code 3Displays the chosen code in the 2nd "Other" selection field.
Diagnosis Code 3 DescriptionDisplays an abbreviated description of the chosen code in the 2nd "Other" selection field.
Diagnosis Code 4Displays the chosen code in the 3rd "Other" selection field.
Diagnosis Code 4 DescriptionDisplays an abbreviated description of the chosen code in the 3rd "Other" selection field.
Diagnosis Code 5Displays the chosen code in the 4th "Other" selection field.
Diagnosis Code 5 DescriptionDisplays an abbreviated description of the chosen code in the 4th "Other" selection field.
Diagnosis Code 6Displays the chosen code in the 5th "Other" selection field.
Diagnosis Code 6 DescriptionDisplays an abbreviated description of the chosen code in the 5th "Other" selection field.
Diagnosis Code 7Displays the chosen code in the 6th "Other" selection field.
Diagnosis Code 7 DescriptionDisplays an abbreviated description of the chosen code in the 6th "Other" selection field.
Diagnosis Code 8Displays the chosen code in the 7th "Other" selection field.
Diagnosis Code 8 DescriptionDisplays an abbreviated description of the chosen code in the 7th "Other" selection field.
Diagnosis Code 9Displays the chosen code in the 8th "Other" selection field.
Diagnosis Code 9 DescriptionDisplays an abbreviated description of the chosen code in the 8th "Other" selection field.
Diagnosis Code 10Displays the chosen code in the 9th "Other" selection field.
Diagnosis Code 10 DescriptionDisplays an abbreviated description of the chosen code in the 9th "Other" selection field.
Diagnosis Code 11Displays the chosen code in the 10th "Other" selection field.
Diagnosis Code 11 DescriptionDisplays an abbreviated description of the chosen code in the 10th "Other" selection field.
Diagnosis Code 12Displays the chosen code in the 11th "Other" selection field.
Diagnosis Code 12 DescriptionDisplays an abbreviated description of the chosen code in the 11th "Other" selection field.
Diagnosis Code 13Displays the chosen code in the 12th "Other" selection field.
Diagnosis Code 13 DescriptionDisplays an abbreviated description of the chosen code in the 12th "Other" selection field.
Diagnosis Code 14Displays the chosen code in the 13th "Other" selection field.
Diagnosis Code 14 DescriptionDisplays an abbreviated description of the chosen code in the 13th "Other" selection field.
Diagnosis Code 15Displays the chosen code in the 14th "Other" selection field.
Diagnosis Code 15 DescriptionDisplays an abbreviated description of the chosen code in the 14th "Other" selection field.
Diagnosis Code 16Displays the chosen code in the 15th "Other" selection field.
Diagnosis Code 16 DescriptionDisplays an abbreviated description of the chosen code in the 15th "Other" selection field.
Diagnosis Code 17Displays the chosen code in the 16th "Other" selection field.
Diagnosis Code 17 DescriptionDisplays an abbreviated description of the chosen code in the 16th "Other" selection field.
Diagnosis Code 18Displays the chosen code in the 17th "Other" selection field.
Diagnosis Code 18 DescriptionDisplays an abbreviated description of the chosen code in the 17th "Other" selection field.
E Code 1Displays the chosen code in the 1st "E Code" selection field.
E Code 1 DescriptionDisplays an abbreviated description of the chosen code in the 1st "E Code" selection field.
E Code 2Displays the chosen code in the 2nd "E Code" selection field.
E Code 2 DescriptionDisplays an abbreviated description of the chosen code in the 2nd "E Code" selection field.
E Code 3Displays the chosen code in the 3rd "E Code" selection field.
E Code 3 DescriptionDisplays an abbreviated description of the chosen code in the 3rd "E Code" selection field.
E Code 4Displays the chosen code in the 4th "E Code" selection field.
E Code 4 DescriptionDisplays an abbreviated description of the chosen code in the 4th "E Code" selection field.
E Code 5Displays the chosen code in the 5th "E Code" selection field.
E Code 5 DescriptionDisplays an abbreviated description of the chosen code in the 5th "E Code" selection field.
E Code 6Displays the chosen code in the 6th "E Code" selection field.
E Code 6 DescriptionDisplays an abbreviated description of the chosen code in the 6th "E Code" selection field.
E Code 7Displays the chosen code in the 7th "E Code" selection field.
E Code 7 DescriptionDisplays an abbreviated description of the chosen code in the 7th "E Code" selection field.
E Code 8Displays the chosen code in the 8th "E Code" selection field.
E Code 8 DescriptionDisplays an abbreviated description of the chosen code in the 8th "E Code" selection field.
E Code 9Displays the chosen code in the 9th "E Code" selection field.
E Code 9 DescriptionDisplays an abbreviated description of the chosen code in the 9th "E Code" selection field.
E Code 10Displays the chosen code in the 10th "E Code" selection field.
E Code 10 DescriptionDisplays an abbreviated description of the chosen code in the 10th "E Code" selection field.
E Code 11Displays the chosen code in the 11th "E Code" selection field.
E Code 11 DescriptionDisplays an abbreviated description of the chosen code in the 11th "E Code" selection field.
E Code 12Displays the chosen code in the 12th "E Code" selection field.
E Code 12 DescriptionDisplays an abbreviated description of the chosen code in the 12th "E Code" selection field.
Principal DiagnosisDisplays the chosen code in the "Principal" selection field.
Principal Diagnosis DescriptionDisplays an abbreviated description of the chosen code in the "Principal" selection field. 


Institutional - Additional Info

The additional info sub-category (under the Institutional sub-category) holds additional information specifically associated with Institutional claims. All of the fields under this sub-category correspond directly with fields found under the Additional Info tab within the Claim section of the application of an Institutional Claim. 

 Name Description
Admission HourDisplays the chosen option in the "Admission Hour" field.
Admission SourceDisplays the chosen option in the "Admission Source" field.
Admission TypeDisplays the chosen option in the "Admission Type" field.
Discharge HourDisplays the chosen option in the "Discharge Hour" field.
Patient StatusDisplays the chosen option in the "Patient Status" field.
Admission DateAssociated with the "Admission Date" field.
PPS (Diagnosis Related Group)Displays the entered information on the "PPS (Diagnosis Related Group)" field.


Professional - Additional Info

The Additional Info sub-category holds information specifically associated with Professional claims. All of the fields under this sub-category correspond directly with fields found under the Additional Info tab within the Claim section of the application of a Professional claim. 

 Name Description
Accept Assignment?Associated with the "Accept Assignment (Box 27)" field. This report field:

  • Displays "No" if the Accept Assignment field is set to No.
  • Displays "Yes' if the Accept Assignment field is set to Yes.
  • Displays "Default" if the Accept Assignment field is set to Default.
Accident StateAssociated with the "Accident State" field.
Ambulatory Patient GroupAssociated with the "Ambulatory Patient Group" field.
Auto Related?Displays "Yes" if the "Is this claim auto accident related (box 10)" field is set to "Yes". Otherwise, this field will display "No".
Box 10-DAssociated with the "Box 10-D" field.
Box 19Associated with the "Box 19" field.
Delay Reason CodeDisplays the chosen option in the "Delay Reason Code" combo box.
Demonstration ProjectAssociated with the "Demonstration Project' field.
Documentation MethodDisplays the chosen option in the "Delay Reason Code" combo box.
Documentation TypeDisplays the chosen option in the "Type" combo box next to the "Documentation Method" field. This field will display "None" if no option has been selected.
Employment Related?Displays "Yes" if the "Is this claim employment related (box 10)" field is set to "Yes". Otherwise, this field will display "No".
GBHC NumberAssociated with the "GBHC Referral Number" field.
Homebound?Displays "Yes" if the "Homebound" field is set to "Yes". Otherwise, this field will display "No".
Investigation Device ExemptionAssociated with the "Investigation Device Exemption" field.
Mammography CertificationAssociated with the "Mammography Certification" field.
Other Related?Displays "Yes" if the "Is this claim other accident related (box 10)" field is set to "Yes". Otherwise, this field will display "No".
Resubmit CodeAssociated with the "Resubmit Reason Code (box 22)" field.
Service Auth. ExceptionDisplays the chosen option in the "Service Authorization Exception" selection field. If no selection has been made, this field will display "None".
Signature in Box 12?Displays the chosen option in the "Print SIGNATURE ON FILE in Box 12" selection field.
Signature in Box 13?Displays the chosen option in the "Print SIGNATURE ON FILE in Box 13" selection field.
Special Program CodeDisplays the chosen option in the "Special Program Code" selection field. If no selection has been made, this field will display "None".
TPL CodeAssociated with the "Payer Assigned TPL Code" field.
TPL Status CodeDisplays the chosen option in the "TPL Status Code" selection field. If no selection has been made, this field will display "None".
Hospitalized Form DateAssociated with the "Hospitalized From Date (box 18)" field.
Hospitalized To DateAssociated with the "To Date" field next to the "Hospitalized From Date (box 18)" field.
Initial TreatmentAssociated with the "Initial Treatment" field.
Last Menstrual PeriodAssociated with the "Last Menstrual Period" field.
Last SeenAssociated with the "Date Last Seen" field.
Onset of IllnessAssociated with the "Date of Onset of Illness or Accident (box 14)" field.
Similar IllnessAssociated with the "Date of Similar Illness (box 15)" field.
Unable to Work From DateAssociated with the "Unable to Work From Date (box 16)" field.
Unable to Work To DateAssociated with the "To Date" next to the "Unable to Work From Date (box 16)" field.
Patient HeightAssociated with the "Height (in.)" field.
Patient WeightAssociated with the "Patient Weight (lbs.)" field.
Lab ChargesAssociated with the "Lab Charges (box 20)" field.


Professional - Ambulance Info

The Ambulance Info sub-category (under the Professional sub-category) holds ambulance information specifically associated with Professional claims. All of the fields under this sub-category correspond directly with fields found under the Additional Info > Ambulance tab within the Claims section of the application of a Professional claim. 

 Name Description
Dropoff Address 1Associated with the first "Address" field of the Dropoff Address.
Dropoff Address 2Associated with the second "Address" field of the Dropoff Address.
Dropoff CityAssociated with the "City" field of the Dropoff Address.
Dropoff StateAssociated with the "State" field of the Dropoff Address.
Dropoff Address 1Associated with the first "Address" field of the Pickup Address.
Pickup CityAssociated with the "City" field of the Pickup Address.
Pickup StateAssociated with the "State" field of the Pickup Address.
Round Trip ReasonAssociated with the "Round Trip Reason" field.
Stretcher ReasonAssociated with the "Stretcher Reason" field.
Transport ReasonDisplays the chosen option in the "Transport Reason" selection field. If no selection has been made, this field will display "None".
Dropoff Zip CodeAssociated with the "Zipcode" field of the Dropoff Address.
Patient WeightAssociated with the "Patient Weight" field.
Patient Zip CodeAssociated with the "Zipcode" field of the Pickup Address.
Transport MilesAssociated with the "Transport Miles" field.


Professional - Diagnosis Codes

The Diagnosis Codes sub-category (under the Professional sub-category) holds diagnosis codes specifically associated with the Professional claims. All of the fields under this sub-category correspond directly with ICD codes associated to the charges of a Professional claim. 

 Name Description
ICD 1Associated with the "ICD #1" field.
ICD 1 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #1" selection field.
ICD 2Associated with the "ICD #2" field.
ICD 2 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #2" selection field.
ICD 3Associated with the "ICD #3" field.
ICD 3 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #3" selection field.
ICD 4Associated with the "ICD #4" field.
ICD 4 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #4" selection field.
ICD 5Associated with the "ICD #5" field.
ICD 5 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #5" selection field.
ICD 6Associated with the "ICD #6" field.
ICD 6 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #6" selection field.
ICD 7Associated with the "ICD #7" field.
ICD 7 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #7" selection field.
ICD 8Associated with the "ICD #8" field.
ICD 8 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #8" selection field.
ICD 9Associated with the "ICD #9" field.
ICD 9 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #9" selection field.
ICD 10Associated with the "ICD #10" field.
ICD 10 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #10" selection field.
ICD 11Associated with the "ICD #11" field.
ICD 11 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #11" selection field.
ICD 12Associated with the "ICD #12" field.
ICD 12 DescriptionDisplays an abbreviated description of the chosen code in the "ICD #12" selection field.


Primary Payer


 Name Description
Payer IDDisplays the unique identifier of the claim's primary payer.
Authorization #Associated with the "Authorization #" field for the primary payer.
Group #Associated with the "Group #" field for the primary payer.
Has Primary?Displays "Yes" if the claim has a primary payer. Displays "No" otherwise.
Member IDAssociated with the "Member ID" field for the primary payer.
NameDisplays the name of the claim's primary payer.
Orig. Claim #Associated with the "Orig. Claim #" field for the primary payer.
Payer TypeDisplays the payer type of the claim's primary payer.
Transmission TypeDisplays the most recent transmission type sent to the claim's primary payer.

  • Displays "Clearinghouse sent electronically" if the claim was sent electronically to the payer.
  • Displays "Clearinghouse sent on paper HCFA" if the claim was sent on paper to the payer by the clearinghouse. 
  • Displays "User printed claim" if the claim was printed to the payer by a user.
Last Billed AmountDisplays the most recent claim amount billed to the claim's primary payer.


Secondary Payer


 Name Description
Payer IDDisplays the unique identifier of the claim's secondary payer.
Authorization #Associated with the "Authorization #" field for the secondary payer.
Group #Associated with the "Group #" field for the secondary payer.
Has Primary?Displays "Yes" if the claim has a secondary payer. Displays "No" otherwise.
Member IDAssociated with the "Member ID" field for the secondary payer.
NameDisplays the name of the claim's secondary payer.
Orig. Claim #Associated with the "Orig. Claim #" field for the secondary payer.
Payer TypeDisplays the payer type of claim's secondary payer.
Transmission TypeDisplays the most recent transmission types sent to the claim's secondary payer.

  • Displays "Clearinghouse sent electronically" if the claim was sent electronically to the payer.
  • Displays "Clearinghouse sent on paper HCFA" if the claim was sent on paper to the payer by the clearinghouse.
  • Displays "User Printed claim" if the claim was printed to the payer by a user.
Last Billed AmountDisplays the most recent claim amount billed to the claim's tertiary payer.


Tertiary Payer


 Name Description
Payer IDDisplays the unique identifier of the claim's tertiary payer.
Authorization #Associated with the "Authorization #" field for the tertiary payer.
Group #Associated with the "Group #" field for the tertiary payer.
Has Primary?Displays "Yes" if the claim has a tertiary payer. Displays "No" otherwise.
Member IDAssociated with the "Member ID" field for the tertiary payer.
NameDisplays the name of the claim's tertiary payer.
Orig. Claim #Associated with the "Orig. Claim #" field for the tertiary payer.
Payer TypeDisplays the payer type of the claim's tertiary payer.
Transmission TypeDisplays the most recent transmission type sent to the claim's tertiary payer.

  • Displays "Clearinghouse electronically" if the claim was sent electronically to the payer.
  • Displays "Clearinghouse sent on paper HCFA" if the claim was sent on paper to the payer by the clearinghouse.
  • Displays "User printed claim" if the claim was printed to the payer by a user.
Last Billed AmountDisplays the most recent claim amount billed to the claim's tertiary payer.


Claim Follow up


 Name Description
Check #Associated with the "Check #" field on the Follow up Activity tab.
Insurance #Associated with the "Insurance #" field on the Follow up Activity tab.
Reference #Associated with the "Reference #" field on the Follow up Activity tab.
Check DateAssociated with the "Check Date" field on the Follow up Activity tab.
Allowed AmountAssociated with the "Allowed Amount" field on the Follow up Activity tab.
Paid AmountAssociated with the "Paid Amount" field on the Follow up Activity tab.