Claim Number A system assigned number used to identify a claim.
Dates of Service From-Through The first and last dates that services were performed for this claim.
Category Code Category codes are HIPAA-defined.
Status and Date The current status of the claim, and the date this status went into
effect. Status codes are HIPAA-defined.
Billed Amount The amount billed on the claim.
Payment The amount
paid to the patient or provider before
adjustments.
Payment Method The method of payment.
Check Number If a payment has been paid towards this claim, the check number used
will be shown. If the Claim number
field is blank, no payment has been made.
Patient
Name
Date of
Birth
Gender
Bill Type
Medical
Record Number
Service Date The date the service was performed.
Service Qual This code is HIPAA-defined.
Service Code Three-digit code which represents the place of service.
Procedure Modifiers Procedure modifier codes.
Charge The dollar amount charged to the patient for the procedure.
Payment If a payment has been paid towards this claim, the amount paid will
be shown. If this field is blank, a payment has not been made.
Units
Category Code Category codes are HIPAA-defined.
Status and Date The current status of the claim, and the date this status went into
effect. Status codes are HIPAA-defined.
Control Number If a claim comes in electronically, it may have a control number. If
it was manually entered, it will not have one.