Superbill Variables

Appointment Information

Field DescriptionField ID
Appointment Alert on the Patient@APPTALERT
Appointment Chief Complaint@APPTCC
Appointment Comments@APPTCOM
Appointment Date@APPTDATE
Appointment Facility@APPTFAC
Appointment Notes - Last Note Added to Appointment@APPTNOTE
Appointment Provider@APPTPRV
Appointment Resource@APPTRES
Appointment Time@APPTTIME
Appointment Type@APPTTYPE
Next Appointment Date@NEXTAPPTDT
Next Appointment time@NEXTAPPT-TIME
Patient Last Seen@PSEEN

Facility Information

Field DescriptionField ID
Address Line 1@FACADDR
Address Line 2@FACADDR2

Default Primary Policy

Field DescriptionField ID
Primary Payer Name@INS1
Primary Policy Group #@INS1GRP
Primary Policy Member ID@INS1MEM
Primary Payer Address 1@INS1ADDR
Primary Payer Address 2@INS1ADDR2
Primary Payer City@INS1CITY
Primary Payer State@INS1STATE
Primary Payer Zip@INS1ZIP
Primary Payer Phone@INS1PH
Primary Payer Copay@PCOP
Primary Policy Co-Insurance@PCOINS
Primary Patient Deductible@PDEDUCT

Default Secondary Policy

Field DescriptionField ID
Secondary Payer Name@INS2
Secondary Policy Group #@INS2GRP
Secondary Policy Member ID@INS2MEM
Secondary Payer Address 1@INS2ADDR
Secondary Payer Address 2@INS2ADDR2
Secondary Payer City@INS2CITY
Secondary Payer State@INS2STATE
Secondary Payer Zip@INS2ZIP
Secondary Payer Phone@INS2PH
Secondary Payer Copay@SCOP
Secondary Policy Co-Insurance@SCOINS
Secondary Patient Deductible@SDEDUCT

Default Tertiary Policy

Field DescriptionField ID
Tertiary Payer Name@INS3
Tertiary Policy Group #@INS3GRP
Tertiary Policy Member ID@INS3MEM
Tertiary Payer Address 1@INS3ADDR
Tertiary Payer Address 2@INS3ADDR2
Tertiary Payer City@INS3CITY
Tertiary Payer State@INS3STATE
Tertiary Payer Zip@INS3ZIP
Tertiary Payer Phone@INS3PH
Tertiary Payer Copay@TCOP
Tertiary Policy Co-Insurance@TCOINS
Tertiary Patient Deductible@TDEDUCT

Default Primary Insured

Field DescriptionField ID
Primary Insured Last Name@PILAST
Primary Insured First Name@PIFIRST
Primary Insured Middle Name@PIMI
Primary Insured Name (Last, First Middle)@PINAME1
Primary Insured Name (First Middle Last)@PINAME2
Primary Insured Address 1@PIADDR1
Primary Insured Address 2@PIADDR2
Primary Insured City@PICITY
Primary Insured State@PISTATE
Primary Insured Zip@PIZIP
Primary Insured Home Phone@PIHOME
Primary Insured Work Phone@PIWORK
Primary Insured Cell Phone@PICELL

Default Secondary Insured

Field DescriptionField ID
Secondary Last Name@SILAST
Secondary Insured First Name@SIFIRST
Secondary Insured Middle Name@SIMI
Secondary Insured Name (Last, First Middle)@SINAME1
Secondary Insured Name (First Middle Last)@SINAME2
Secondary Insured Address 1@SIADDR1
Secondary Insured Address 2@SIADDR2
Secondary Insured City@SICITY
Secondary Insured State@SISTATE
Secondary Insured Zip@SIZIP
Secondary Insured Home Phone@SIHOME
Secondary Insured Work Phone@SIWORK
Secondary Insured Cell Phone@SICELL

Default Tertiary Insured

Field DescriptionField ID
Tertiary Last Name@TILAST
Tertiary Insured First Name@TIFIRST
Tertiary Insured Middle Name@TIMI
Tertiary Insured Name (Last, First Middle)@TINAME1
Tertiary Insured Name (First Middle Last)@TINAME2
Tertiary Insured Address 1@TIADDR1
Tertiary Insured Address 2@TIADDR2
Tertiary Insured City@TICITY
Tertiary Insured State@TISTATE
Tertiary Insured Zip@TIZIP
Tertiary Insured Home Phone@TIHOME
Tertiary Insured Work Phone@TIWORK
Tertiary Insured Cell Phone@TICELL

Patient Information

Field DescriptionField ID
Address Line 1@PADDR1
Address Line 2@PADDR2
Balance Due Insurance@IBAL
Balance Due Patient@PBAL
Balance Due Collection@CBAL
Cell Phone@PCELL
Credits Due Insurance@PCRI
Credits Due Patient@PCRP
Patient's Unapplied Copay Credit amount
Date of Birth@PDOB
First Name@PFIRST
Full Address (Address City State Zip)@PADDRFULL
Full Name (First MI Last)@PNAME2
Full Name (Last, First MI)@PNAME1
Home Phone@PHOME
Last Name@PLAST
Last Seen Date@PLASTSEEN
Middle Initial@PMI
Patient Reference@PREF
Work Phone@PWORK
Zip Code@PZIP

Payer Information

Field DescriptionField ID
Primary Payer Group Number@IN1GRP
Primary Payer Member Number@IN1MEM
Primary Payer Name@TIN1
Secondary Payer Group Number@IN2GRP
Secondary Payer Member Number@IN2MEM
Secondary Payer Name@TIN2
Primary Payer Address 1@AINADDR1
Primary Payer Address 2@AINADDR2
Primary Payer City@AIN1CITY
Primary Payer Phone@AIN1PH
Primary Payer State@AIN1STATE
Primary Payer Zip Code@AIN1ZIP
Secondary Payer Address 1@AIN2ADDR1
Secondary Payer Address 2@AIN2ADDR2
Secondary Payer City@AIN2CITY
Secondary Payer Phone@AIN2PH
Secondary Payer State@AIN2STATE
Secondary Payer Zip Code@AUB2ZIP

Payment Plan Information

Field DescriptionField ID
Next Installment Due Date@NEXTINSTALLDATE
Next Installment Due Amount@NEXTINSTALLAMTDUE
Overdue Balance Amount@OVERDUEBAL
Total Payment Plan Balance@PAYPLANBAL

Practice Information

Field DescriptionField ID
Address Line 1@PRADDR1
Address Line 2@PRADDR2
Full Address (Address City State Zip)@PRADDFULL
Zip Code@PRZIP

Provider Information

Field DescriptionField ID
Provider Name@PRVNAME
Provider's Tax ID@PRTAX

Referring Information

Field DescriptionField ID
Address Line 1@REFADDR1
Address Line 2@REFADDR2

Other Information

Field DescriptionField ID
Today's Charge Amount@TODCHGS
Today's Date@TODAY