Claim Lists

Field Name

Definition

Patient Account #

Unique identifier assigned to an individual patient by the provider / biller for billing and administrative purposes.

Patient Birth Date

The date of birth of the patient, crucial for accurately processing medical claims and determining eligibility.

Patient Sex

The gender of the patient (e.g., Male, Female, Other) for demographic information and insurance verification.

Patient Address 1

The primary address of the patient where correspondence and bills are sent.

Patient City

The city associated with the patient's primary address.

Patient State

The state associated with the patient's primary address.

Patient Zip

The postal code corresponding to the patient's primary address.

Payer ID

A unique identifier assigned to a healthcare payer, facilitating claims processing and coordination of benefits.

Payer Name

The name of the healthcare insurance or payer responsible for processing the claim.

Insured ID

A unique identifier assigned to the insured individual covered by the insurance policy.

Insured Group

The group or employer identification associated with the insured individual's insurance coverage.

Insured Plan

The specific insurance plan under which the insured individual is covered.

Insured Last Name

The last name of the insured individual for identification and record-keeping.

Insured First Name

The first name of the insured individual for identification and record-keeping.

Insured Birth Date

The date of birth of the insured individual, crucial for accurately processing medical claims and determining eligibility.

Insured Sex

The gender of the insured individual (e.g., Male, Female, Other) for demographic information and insurance verification.

Insured Address 1

The primary address of the insured individual where correspondence and bills are sent.

Insured City

The city associated with the insured individual's primary address.

Insured State

The state associated with the insured individual's primary address.

Insured Zip

The postal code corresponding to the insured individual's primary address.

First Date of Service / Statement From Date

The initial date of service or the beginning date of the billing statement.

Last Date of Service / Statement Thru Date

The final date of service or the end date of the billing statement.

Total Charge

The total amount charged for the medical services rendered.

Billing Provider Name

The name of the healthcare provider or entity submitting the medical claim.

Billing Provider NPI

The National Provider Identifier assigned to the billing healthcare provider.

Billing Provider Legacy ID

An older or alternative identifier for the billing healthcare provider.

Billing Provider Taxonomy

A code that classifies the specialty and type of healthcare provider.

Billing Provider Address 1

The primary address of the billing healthcare provider.

Billing Provider City

The city associated with the billing healthcare provider's primary address.

Billing Provider State

The state associated with the billing healthcare provider's primary address.

Billing Provider Zip

The postal code corresponding to the billing healthcare provider's primary address.

Rendering Provider Last Name

The last name of the healthcare provider who rendered the services.

Rendering Provider First Name

The first name of the healthcare provider who rendered the services.

Rendering Provider NPI

The National Provider Identifier assigned to the healthcare provider who rendered the services.

Rendering Provider Legacy ID

An older or alternative identifier for the healthcare provider who rendered the services.

Rendering Provider Taxonomy

A code that classifies the specialty and type of healthcare provider who rendered the services.

Diagnosis A through H

Codes representing specific medical diagnoses associated with the patient's condition.

Primary or Secondary

Indicates whether the listed diagnosis is primary or secondary in relation to the patient's condition.

Referring Provider NPI

The National Provider Identifier assigned to the referring healthcare provider.

Referring Provider Last Name

The last name of the healthcare provider who referred the patient for services.

Referring Provider First Name

The first name of the healthcare provider who referred the patient for services.

Outgoing Payer Claim ID

Identifier assigned by the clearinghouse to outgoing claims for tracking and processing purposes.

Prior Authorization #

A pre-approval number obtained from the payer to authorize specific medical services or procedures.

CLIA #

Clinical Laboratory Improvement Amendments number, required for laboratories performing certain diagnostic tests.

Procedure Narrative

A description of the medical procedure or service provided, aiding in claim adjudication.

Billing Provider Tax ID

The Tax Identification Number associated with the billing healthcare provider.

Facility NPI

The National Provider Identifier assigned to the healthcare facility.

Facility Legacy ID

An older or alternative identifier for the healthcare facility.

Facility Name

The name of the healthcare facility where the services were provided.

Facility Address 1

The primary address of the healthcare facility where the services were provided.

Facility City

The city associated with the healthcare facility's primary address.

Facility State

The state associated with the healthcare facility's primary address.

Facility Zip

The postal code corresponding to the healthcare facility's primary address.

Claim Status Time

The most recent date/time when the claim underwent either a modification, transmission, or rejection.

CLAIM.MD Claim ID

Unique identifier assigned by CLAIM.MD to track and manage the claim within its system.

Remote Claimid

Identifier associated with the claim in a remote system, if applicable.

User Charge ID

Identifier assigned to the user for billing purposes or tracking in the system.

Procedure Code

A standardized code representing the specific medical procedure or service provided.

From Date

The starting date relevant to the claim or medical service.

Place of Service

Code indicating the location where the medical services were rendered.

NDC Code

National Drug Code, a unique identifier for pharmaceuticals and medical products.

Rev Code

Revenue Code, used to categorize specific services for billing and reimbursement.

Modifiers

Additional codes providing extra information about the services rendered.

Units

The quantity or number of units associated with a specific medical service or procedure.

Payer ICN # (ERA)

Identifier assigned by the payer to the electronic remittance advice (ERA) for tracking purposes.

Claim Form

The standard form used to submit a claim for reimbursement of healthcare services (i.e. 1500, UB-04, Dental).