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FIELD NAME |
DEFINITIONS AND EXPLANATIONS |
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Service Date |
The date the service for a specific procedure or service was performed. |
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Service Code |
Three-character code for a specific service. A brief description of the code is shown in the Service Code Description field, in Row #3. |
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Charge |
The amount charged / billed for the specific service or procedure. |
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Not Paid |
The amount of the charge that is not covered under the benefit plan. |
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Reason Code |
This two-character code represents the reason that the claimed service or procedure charge was adjusted or denied. A brief description of the code is shown in the Reason Code Description field, in Row #3. |
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Covered |
The total covered amount for the claim. This is the amount of the claim that your insurance will pay. |
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Deductible |
The dollar amount that you are responsible for paying. |
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Co Ins % |
The percentage of the service charge that your insurance covers. |
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Co Ins Dollars |
The dollar amount that your insurance covers for the listed service. |
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Payment
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The amount paid to the patient or provider before adjustments. |
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Totals |
Lists the total charges, total not-paid amounts, total covered amounts, total deductible amounts, total co-insurance dollars and total payments, in that order, for the preceding service lines of the claim. |