Encounter Primary |
Encounter Primary Adjustments | Encounter Primary Adjustments |
Encounter Primary Allowed Amounts | Encounter Primary Allowed Amounts |
Encounter Primary City | Encounter Primary City |
Encounter Primary City, State Zip | Encounter Primary City, State Zip |
Encounter Primary Contact Full Name | Encounter Primary Contact Full Name |
Encounter Primary Copay Amount | Encounter Primary Co-pay Amount |
Encounter Primary Deductible | Encounter Primary Deductible |
Encounter Primary Deductions | Encounter Primary Deductions |
Encounter Primary Group # | Encounter Primary Group # |
Encounter Primary Group Name | Encounter Primary Group Name |
Encounter Primary Insured Address Line 1 | Encounter Primary Insured Address Line 1 |
Encounter Primary Insured Address Line 2 | Encounter Primary Insured Address Line 2 |
Encounter Primary Insured City | Encounter Primary Insured City |
Encounter Primary Insured Country | Encounter Primary Insured Country |
Encounter Primary Insured County | Encounter Primary Insured County |
Encounter Primary Insured DOB | Encounter Primary Insured DOB |
Encounter Primary Insured Employer | Encounter Primary Insured Employer |
Encounter Primary Insured Name | Encounter Primary Insured Name |
Encounter Primary Insured Occupation | Encounter Primary Insured Occupation |
Encounter Primary Insured Relationship Code to Patient | Encounter Primary Insured Relationship Code to Patient |
Encounter Primary Insured Relationship to Patient | Encounter Primary Insured Relationship to Patient |
Encounter Primary Insured Sex | Encounter Primary Insured Sex |
Encounter Primary Insured SSN | Encounter Primary Insured SSN |
Encounter Primary Insured State | Encounter Primary Insured State |
Encounter Primary Insured Work Phone | Encounter Primary Insured Work Phone |
Encounter Primary Insured Zip | Encounter Primary Insured Zip |
Encounter Primary Last Payment Date | Encounter Primary Last Payment Date |
Encounter Primary Name | Encounter Primary Name |
Encounter Primary Payments | Encounter Primary Payments |
Encounter Primary Phone | Encounter Primary Phone |
Encounter Primary Plan # | Encounter Primary Plan # |
Encounter Primary Policy # | Encounter Primary Policy # |
Encounter Primary Policy Eff Date | Encounter Primary Policy Eff Date |
Encounter Primary Policy Exp Date | Encounter Primary Policy Exp Date |
Encounter Primary State | Encounter Primary State |
Encounter Primary Street Address 1 | Encounter Primary Street Address 1 |
Encounter Primary Street Address 2 | Encounter Primary Street Address 2 |
Encounter Primary Zip | Encounter Primary Zip |
Payer User-Defined 1 Name | Payer User-Defined 1 Name |
Encounter Secondary |
Encounter Sec City | Encounter Secondary City |
Encounter Sec City, State Zip | Encounter Secondary City, State Zip |
Encounter Sec Group # | Encounter Secondary Group # |
Encounter Sec Group Na... | Encounter Secondary Group Name |
Encounter Sec Name | Encounter Secondary Name |
Encounter Sec Phone | Encounter Secondary Phone |
Encounter Sec Plan # | Encounter Secondary Plan # |
Encounter Sec Policy # | Encounter Secondary Policy # |
Encounter Sec Prov Addr... | Encounter Sec Prov Address1 |
Encounter Sec Prov Addr... | Encounter Sec Prov Address2 |
Encounter Sec Prov City, State… | Encounter Secondary Provider City, State Zip |
Encounter Sec Prov Claim Val 1 | Encounter Secondary Provider Claim Value 1 |
Encounter Sec Prov Claim Val 2 | Encounter Secondary Provider Claim Value 2 |
Encounter Sec Provider Name | Encounter Secondary Provider Name |
Encounter Sec Provider Name First Last | Prints the secondary provider's name as First Middle Last. For example, John Jimmy Smith instead of Smith, John Jimmy |
Encounter Sec Ref Prov Name | Encounter Secondary Referring Provider Name |
Encounter Sec Ref Prov Payer # | Encounter Secondary Referring Provider Payer # |
Encounter Sec Renderin... | Encounter Secondary Rendering Group # |
Encounter Sec Renderin... | Encounter Secondary Rendering Provider # |
Encounter Sec State | Encounter Secondary State |
Encounter Sec Street Ad... | Encounter Secondary Street Address 1 |
Encounter Sec Street Ad... | Encounter Secondary Street Address 2 |
Encounter Sec Zip | Encounter Secondary Zip |
Encounter Secondary Co... | Encounter Secondary Contact Full Name |
Encounter Secondary Ins... | Encounter Secondary Insured Address Line 1 |
Encounter Secondary Ins... | Encounter Secondary Insured Address Line 2 |
Encounter Secondary Ins... | Encounter Secondary Insured City |
Encounter Secondary Ins... | Encounter Secondary Insured Country |
Encounter Secondary Ins... | Encounter Secondary Insured County |
Encounter Secondary Ins... | Encounter Secondary Insured DOB |
Encounter Secondary Ins... | Encounter Secondary Insured Employer |
Encounter Secondary Ins... | Encounter Secondary Insured Name |
Encounter Secondary Ins... | Encounter Secondary Insured Occupation |
Encounter Secondary Ins... | Encounter Secondary Insured Relationship to Patient |
Encounter Secondary Ins... | Encounter Secondary Insured Sex |
Encounter Secondary Ins... | Encounter Secondary Insured SSN |
Encounter Secondary Ins... | Encounter Secondary Insured State |
Encounter Secondary Ins... | Encounter Secondary Insured Work Phone |
Encounter Secondary Ins... | Encounter Secondary Insured Zip |
Encounter Tertiary |
Encounter Tert Prov Address 1 | Encounter Tertiary Provider Address 1 |
Encounter Tert Prov Address 2 | Encounter Tertiary Provider Address 2 |
Encounter Tert Prov Clai... | Encounter Tertiary Provider Claim Value 1 |
Encounter Tert Prov Clai... | Encounter Tertiary Provider Claim Value 2 |
Encounter Tert Ref Prov... | Encounter Tertiary Referring Provider Name |
Encounter Tert Ref Prov... | Encounter Tertiary Referring Provider Payer # |
Encounter Tert Renderin... | Encounter Tertiary Rendering Group # |
Encounter Tert Renderin... | Encounter Tertiary Rendering Provider # |
Encounter Tertiary Conta... | Encounter Tertiary Contact Full Name |
Encounter Tertiary Insure... | Encounter Tertiary Insured Address Line 1 |
Encounter Tertiary Insure... | Encounter Tertiary Insured Address Line 2 |
Encounter Tertiary Insure... | Encounter Tertiary Insured City |
Encounter Tertiary Insure... | Encounter Tertiary Insured Country |
Encounter Tertiary Insure... | Encounter Tertiary Insured County |
Encounter Tertiary Insure... | Encounter Tertiary Insured DOB |
Encounter Tertiary Insure... | Encounter Tertiary Insured Employer |
Encounter Tertiary Insure... | Encounter Tertiary Insured Name |
Encounter Tertiary Insure... | Encounter Tertiary Insured Occupation |
Encounter Tertiary Insure... | Encounter Tertiary Insured Relationship to Patient |
Encounter Tertiary Insure... | Encounter Tertiary Insured Sex |
Encounter Tertiary Insure... | Encounter Tertiary Insured SSN |
Encounter Tertiary Insure... | Encounter Tertiary Insured State |
Encounter Tertiary Insure... | Encounter Tertiary Insured Work Phone |
Encounter Tertiary Insure... | Insured Zip |
Encounter Tertiary Provider City, State Zip | Encounter Tertiary Provider City, State Zip |
Encounter Tertiary Provider Name | Encounter Tertiary Provider Name |
Encounter Tertiary Provider Name First Last | Prints the tertiary provider's name as First Middle Last. For example, John Jimmy Smith instead of Smith, John Jimmy |