Claim Data

Last Modified on 07/16/2020 2:09 pm EDT

Claim Data

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

Name	Description
Claim ID	Displays the unique identifier of a particular claim.
Facility ID	Displays the unique identifier of the facility associated with a claim. If no facility is associated with the claim, this field will display 0.
Office ID	Displays 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 ID	Displays the account number of the patient associated with a claim.
Practice ID	Displays the unique identifier of the practice associated with a claim
Referring Provider ID	Displays the unique identifier of the referring provider associated with a claim.
Rendering Provider ID	Displays the unique identifier of the rendering provider associated with a claim.
Created by Interface?	Displays "Yes" if the claim was created by an interface. This can be useful as a filter to only show claims that are created by an interface.
Current Payer Priority	Displays 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 List	Displays 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.
Type	Displays this claim's type, which can be one of the following: Professional Institutional
Username	Displays the username of the user that last created/altered the claim.
Date Entered	Displays the date that this claim was entered into the application.
Followup Date	Displays the Followup Date of the claim.
From Date	Displays the From Date of the claim.
Set to Status Due	Displays the date that this claim's status was last updated.
To Date	Displays the To Date of the claim.
Amount Paid	Displays the total amount that has been paid on this claim.
Balance	Displays the total amount of this claim that is still outstanding.
Total Amount	Displays the original total amount of charges on the claim.

Institutional - Diagnosis Codes

Name	Description
Admit Code	Displays the chosen code in the "Admit" selection field.
Admit Code Description	Displays an abbreviated description of the chosen code in the "Admit" selection field.
Diagnosis Code 2	Displays the chosen code in the 1st "Other" selection field.
Diagnosis Code 2 Description	Displays an abbreviated description of the chosen code in the 1st "Other" selection field.
Diagnosis Code 3	Displays the chosen code in the 2nd "Other" selection field.
Diagnosis Code 3 Description	Displays an abbreviated description of the chosen code in the 2nd "Other" selection field.
Diagnosis Code 4	Displays the chosen code in the 3rd "Other" selection field.
Diagnosis Code 4 Description	Displays an abbreviated description of the chosen code in the 3rd "Other" selection field.
Diagnosis Code 5	Displays the chosen code in the 4th "Other" selection field.
Diagnosis Code 5 Description	Displays an abbreviated description of the chosen code in the 4th "Other" selection field.
Diagnosis Code 6	Displays the chosen code in the 5th "Other" selection field.
Diagnosis Code 6 Description	Displays an abbreviated description of the chosen code in the 5th "Other" selection field.
Diagnosis Code 7	Displays the chosen code in the 6th "Other" selection field.
Diagnosis Code 7 Description	Displays an abbreviated description of the chosen code in the 6th "Other" selection field.
Diagnosis Code 8	Displays the chosen code in the 7th "Other" selection field.
Diagnosis Code 8 Description	Displays an abbreviated description of the chosen code in the 7th "Other" selection field.
Diagnosis Code 9	Displays the chosen code in the 8th "Other" selection field.
Diagnosis Code 9 Description	Displays an abbreviated description of the chosen code in the 8th "Other" selection field.
Diagnosis Code 10	Displays the chosen code in the 9th "Other" selection field.
Diagnosis Code 10 Description	Displays an abbreviated description of the chosen code in the 9th "Other" selection field.
Diagnosis Code 11	Displays the chosen code in the 10th "Other" selection field.
Diagnosis Code 11 Description	Displays an abbreviated description of the chosen code in the 10th "Other" selection field.
Diagnosis Code 12	Displays the chosen code in the 11th "Other" selection field.
Diagnosis Code 12 Description	Displays an abbreviated description of the chosen code in the 11th "Other" selection field.
Diagnosis Code 13	Displays the chosen code in the 12th "Other" selection field.
Diagnosis Code 13 Description	Displays an abbreviated description of the chosen code in the 12th "Other" selection field.
Diagnosis Code 14	Displays the chosen code in the 13th "Other" selection field.
Diagnosis Code 14 Description	Displays an abbreviated description of the chosen code in the 13th "Other" selection field.
Diagnosis Code 15	Displays the chosen code in the 14th "Other" selection field.
Diagnosis Code 15 Description	Displays an abbreviated description of the chosen code in the 14th "Other" selection field.
Diagnosis Code 16	Displays the chosen code in the 15th "Other" selection field.
Diagnosis Code 16 Description	Displays an abbreviated description of the chosen code in the 15th "Other" selection field.
Diagnosis Code 17	Displays the chosen code in the 16th "Other" selection field.
Diagnosis Code 17 Description	Displays an abbreviated description of the chosen code in the 16th "Other" selection field.
Diagnosis Code 18	Displays the chosen code in the 17th "Other" selection field.
Diagnosis Code 18 Description	Displays an abbreviated description of the chosen code in the 17th "Other" selection field.
E Code 1	Displays the chosen code in the 1st "E Code" selection field.
E Code 1 Description	Displays an abbreviated description of the chosen code in the 1st "E Code" selection field.
E Code 2	Displays the chosen code in the 2nd "E Code" selection field.
E Code 2 Description	Displays an abbreviated description of the chosen code in the 2nd "E Code" selection field.
E Code 3	Displays the chosen code in the 3rd "E Code" selection field.
E Code 3 Description	Displays an abbreviated description of the chosen code in the 3rd "E Code" selection field.
E Code 4	Displays the chosen code in the 4th "E Code" selection field.
E Code 4 Description	Displays an abbreviated description of the chosen code in the 4th "E Code" selection field.
E Code 5	Displays the chosen code in the 5th "E Code" selection field.
E Code 5 Description	Displays an abbreviated description of the chosen code in the 5th "E Code" selection field.
E Code 6	Displays the chosen code in the 6th "E Code" selection field.
E Code 6 Description	Displays an abbreviated description of the chosen code in the 6th "E Code" selection field.
E Code 7	Displays the chosen code in the 7th "E Code" selection field.
E Code 7 Description	Displays an abbreviated description of the chosen code in the 7th "E Code" selection field.
E Code 8	Displays the chosen code in the 8th "E Code" selection field.
E Code 8 Description	Displays an abbreviated description of the chosen code in the 8th "E Code" selection field.
E Code 9	Displays the chosen code in the 9th "E Code" selection field.
E Code 9 Description	Displays an abbreviated description of the chosen code in the 9th "E Code" selection field.
E Code 10	Displays the chosen code in the 10th "E Code" selection field.
E Code 10 Description	Displays an abbreviated description of the chosen code in the 10th "E Code" selection field.
E Code 11	Displays the chosen code in the 11th "E Code" selection field.
E Code 11 Description	Displays an abbreviated description of the chosen code in the 11th "E Code" selection field.
E Code 12	Displays the chosen code in the 12th "E Code" selection field.
E Code 12 Description	Displays an abbreviated description of the chosen code in the 12th "E Code" selection field.
Principal Diagnosis	Displays the chosen code in the "Principal" selection field.
Principal Diagnosis Description	Displays 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 Hour	Displays the chosen option in the "Admission Hour" field.
Admission Source	Displays the chosen option in the "Admission Source" field.
Admission Type	Displays the chosen option in the "Admission Type" field.
Discharge Hour	Displays the chosen option in the "Discharge Hour" field.
Patient Status	Displays the chosen option in the "Patient Status" field.
Admission Date	Associated 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 State	Associated with the "Accident State" field.
Ambulatory Patient Group	Associated 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-D	Associated with the "Box 10-D" field.
Box 19	Associated with the "Box 19" field.
Delay Reason Code	Displays the chosen option in the "Delay Reason Code" combo box.
Demonstration Project	Associated with the "Demonstration Project' field.
Documentation Method	Displays the chosen option in the "Delay Reason Code" combo box.
Documentation Type	Displays 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 Number	Associated 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 Exemption	Associated with the "Investigation Device Exemption" field.
Mammography Certification	Associated 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 Code	Associated with the "Resubmit Reason Code (box 22)" field.
Service Auth. Exception	Displays 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 Code	Displays the chosen option in the "Special Program Code" selection field. If no selection has been made, this field will display "None".
TPL Code	Associated with the "Payer Assigned TPL Code" field.
TPL Status Code	Displays the chosen option in the "TPL Status Code" selection field. If no selection has been made, this field will display "None".
Hospitalized Form Date	Associated with the "Hospitalized From Date (box 18)" field.
Hospitalized To Date	Associated with the "To Date" field next to the "Hospitalized From Date (box 18)" field.
Initial Treatment	Associated with the "Initial Treatment" field.
Last Menstrual Period	Associated with the "Last Menstrual Period" field.
Last Seen	Associated with the "Date Last Seen" field.
Onset of Illness	Associated with the "Date of Onset of Illness or Accident (box 14)" field.
Similar Illness	Associated with the "Date of Similar Illness (box 15)" field.
Unable to Work From Date	Associated with the "Unable to Work From Date (box 16)" field.
Unable to Work To Date	Associated with the "To Date" next to the "Unable to Work From Date (box 16)" field.
Patient Height	Associated with the "Height (in.)" field.
Patient Weight	Associated with the "Patient Weight (lbs.)" field.
Lab Charges	Associated 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 1	Associated with the first "Address" field of the Dropoff Address.
Dropoff Address 2	Associated with the second "Address" field of the Dropoff Address.
Dropoff City	Associated with the "City" field of the Dropoff Address.
Dropoff State	Associated with the "State" field of the Dropoff Address.
Dropoff Address 1	Associated with the first "Address" field of the Pickup Address.
Pickup City	Associated with the "City" field of the Pickup Address.
Pickup State	Associated with the "State" field of the Pickup Address.
Round Trip Reason	Associated with the "Round Trip Reason" field.
Stretcher Reason	Associated with the "Stretcher Reason" field.
Transport Reason	Displays the chosen option in the "Transport Reason" selection field. If no selection has been made, this field will display "None".
Dropoff Zip Code	Associated with the "Zipcode" field of the Dropoff Address.
Patient Weight	Associated with the "Patient Weight" field.
Patient Zip Code	Associated with the "Zipcode" field of the Pickup Address.
Transport Miles	Associated 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 1	Associated with the "ICD #1" field.
ICD 1 Description	Displays an abbreviated description of the chosen code in the "ICD #1" selection field.
ICD 2	Associated with the "ICD #2" field.
ICD 2 Description	Displays an abbreviated description of the chosen code in the "ICD #2" selection field.
ICD 3	Associated with the "ICD #3" field.
ICD 3 Description	Displays an abbreviated description of the chosen code in the "ICD #3" selection field.
ICD 4	Associated with the "ICD #4" field.
ICD 4 Description	Displays an abbreviated description of the chosen code in the "ICD #4" selection field.
ICD 5	Associated with the "ICD #5" field.
ICD 5 Description	Displays an abbreviated description of the chosen code in the "ICD #5" selection field.
ICD 6	Associated with the "ICD #6" field.
ICD 6 Description	Displays an abbreviated description of the chosen code in the "ICD #6" selection field.
ICD 7	Associated with the "ICD #7" field.
ICD 7 Description	Displays an abbreviated description of the chosen code in the "ICD #7" selection field.
ICD 8	Associated with the "ICD #8" field.
ICD 8 Description	Displays an abbreviated description of the chosen code in the "ICD #8" selection field.
ICD 9	Associated with the "ICD #9" field.
ICD 9 Description	Displays an abbreviated description of the chosen code in the "ICD #9" selection field.
ICD 10	Associated with the "ICD #10" field.
ICD 10 Description	Displays an abbreviated description of the chosen code in the "ICD #10" selection field.
ICD 11	Associated with the "ICD #11" field.
ICD 11 Description	Displays an abbreviated description of the chosen code in the "ICD #11" selection field.
ICD 12	Associated with the "ICD #12" field.
ICD 12 Description	Displays an abbreviated description of the chosen code in the "ICD #12" selection field.

Primary Payer

Name	Description
Payer ID	Displays 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 ID	Associated with the "Member ID" field for the primary payer.
Name	Displays the name of the claim's primary payer.
Orig. Claim #	Associated with the "Orig. Claim #" field for the primary payer.
Payer Type	Displays the payer type of the claim's primary payer.
Transmission Type	Displays 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 Amount	Displays the most recent claim amount billed to the claim's primary payer.

Secondary Payer

Name	Description
Payer ID	Displays 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 ID	Associated with the "Member ID" field for the secondary payer.
Name	Displays the name of the claim's secondary payer.
Orig. Claim #	Associated with the "Orig. Claim #" field for the secondary payer.
Payer Type	Displays the payer type of claim's secondary payer.
Transmission Type	Displays 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 Amount	Displays the most recent claim amount billed to the claim's tertiary payer.

Tertiary Payer

Name	Description
Payer ID	Displays 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 ID	Associated with the "Member ID" field for the tertiary payer.
Name	Displays the name of the claim's tertiary payer.
Orig. Claim #	Associated with the "Orig. Claim #" field for the tertiary payer.
Payer Type	Displays the payer type of the claim's tertiary payer.
Transmission Type	Displays 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 Amount	Displays 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 Date	Associated with the "Check Date" field on the Follow up Activity tab.
Allowed Amount	Associated with the "Allowed Amount" field on the Follow up Activity tab.
Paid Amount	Associated with the "Paid Amount" field on the Follow up Activity tab.

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Claim Data

Claim Data

Institutional - Diagnosis Codes

Institutional - Additional Info

Professional - Additional Info

Professional - Ambulance Info

Professional - Diagnosis Codes

Primary Payer

Secondary Payer

Tertiary Payer

Claim Follow up

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