WEBeci Online Help

Claims Detail Screen

The Claims Detail screen shows you a detailed view of a specific claim.  Click on any of the following for a definition of the fields on this screen:

• Claim NumberA system assigned number used to identify a claim.

• Dates of Service From-ThroughThe first and last dates that services were performed for this claim.

• GroupThe Underwriter and Group Code of the group the patient belongs to.

• Social Security NumberThe patient's social security number.

• Status and DateThe current status of the claim, and the date this status went into effect.

• Service DateThe date the service was performed.

• Service CodeThree-digit code which represents the place of service.

• ChargeThe dollar amount charged to the patient for the procedure.

• Covered AmountThe total covered amount for the claim.

• Not PaidAn accumulation of all not-covered amounts.
   

• Reason CodeClaim adjustment reason codes indicate the reason a claim has been adjusted.

• Co Ins %Displays the coinsurance percentage at which the claim was paid.

• PaymentThe amount paid to the patient or provider before adjustments.  
   

• TotalsLists the totals for charges, covered amounts, not paid amounts, and payments prior to adjustments.

• AdjustmentsThe total amount of calculated adjustments.

• Employee/Patient - ProviderLists the patients and/or providers attached to this claim.

• WithholdPPO providers can have withholds done when claims are processed and paid. A portion of the payment amount, per service line, can be withheld according to the option that the provider has selected, either a percentage per line or a flat amount per line. These amounts are not paid to the provider at the time of the claim payment, but can be recouped at the end of the year.

• EncounteredEncountered is when there is a “capitated” dollar amount taken during the pricing of the claim.  This is a negotiated amount for one or more services covered by a capitation agreement and is deducted from the provider’s claim payment.

• PaymentIf 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.

• Check NumberIf 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.

• Service Code DescriptionA description of service codes used within the claim. Service codes are HIPAA-defined.
   

• Reason Code DescriptionA description of reason codes used within the claim. Reason codes are HIPAA-defined.