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| Column Name | Description | Data Populates From |
|---|---|---|
| Prac Name | Practice Name | Practice associated with the patient's encounter |
| Loc Name | Location Name | Encounter Maintenance |
| Location SubGrp 1 | Location Subgrouping 1
| Locations Master File |
| Location SubGrp 2 | Location Subgrouping 2
| Locations Master File |
| E/I | Source Number | Encounter/Invoice |
| Dt of Svc | Date of Service | Charge Posting |
| End Dt of Svc | End Date of Service | Charge Posting |
| Proc Dt | Process Date | Charge Posting |
| Ovr Proc Dt | Override Process Date | Charge Posting |
| Pat Name | Patient Name | Patient Information |
| Addr 1 | Address 1 | Patient Information |
| Addr 2 | Address 1 | Patient Information |
| City | City | Patient Information |
| State | State | Patient Information |
| Zip | Zip Code | Patient Information |
| Sex | Sex Description | Patient Information |
| SSN | Social Security Number | Patient Information |
| Pat Age | Patient Age | Patient Information |
| Pat Age in Years | Patient Age in Years | Patient Information |
| Pat Age in Months | Patient Age in Months | Patient Information |
| Pat Age in Years (DOS) | Patient Age in Years on the Date of Service | Patient Information |
| Pat Age in Months (DOS) | Patient Age in Months on the Date of Service | Patient Information |
| Md Rc | Medical Record Number | Patient Chart |
| Phone | Home Phone | Patient Information |
| Day Phone | Day Phone | Patient Information |
| Guar Name | Guarantor Name | Guarantor Information |
| Guar Addr 1 | Guarantor Address 1 | Guarantor Information |
| Guar Addr 2 | Guarantor Address 2 | Guarantor Information |
| Guar City | Guarantor City | Guarantor Information |
| Guar State | Guarantor State | Guarantor Information |
| Guar Zip | Guarantor Zip Code | Guarantor Information |
| Guar Sex | Guarantor Sex | Guarantor Information |
| Guar Birth Dt | Guarantor Birth Date | Guarantor Information |
| Guar Pat Age | Guarantor Age | Guarantor Information |
| Guar Phone | Guarantor Phone | Guarantor Information |
| Guar Day Phone | Guarantor Day Phone | Guarantor Information |
| Relation | Guarantor's Relation To Patient | Guarantor Information |
| Pat Type | Patient Type | Encounter Maintenance |
| Sv It | Service Item ID | Charge Posting |
| Sv It Desc | Service Item Description | Service Items Library |
| CPT4 | CPT4 | Service Items Library |
| CPT4 Desc | CPT4 Description | Service Items Library |
| Mod 1 | Modifier 1 | Charge Posting |
| Mod 2 | Modifier 2 | Charge Posting |
| Mod 3 | Modifier 3 | Charge Posting |
| Mod 4 | Modifier 4 | Charge Posting |
| Narrative | Narrative | Charge Posting |
| Diag 1 | Diagnosis Code 1 | Charge Posting |
| Diag 2 | Diagnosis Code 2 | Charge Posting |
| Diag 3 | Diagnosis Code 3 | Charge Posting |
| Diag 4 | Diagnosis Code 4 | Charge Posting |
| Diag Desc 1 | Diagnosis Description 1 | Diagnosis Codes Library |
| Diag Desc 2 | Diagnosis Description 2 | Diagnosis Codes Library |
| Diag Desc 3 | Diagnosis Description 3 | Diagnosis Codes Library |
| Diag Desc 4 | Diagnosis Description 4 | Diagnosis Codes Library |
| Notes | Notes | Charge Posting |
| Ovr | Charge Override Price | Charge Posting |
| Unit Price | Charge Unit Price | Charge Posting |
| Chg Amt | Charge Amount | Charge Posting |
| Count | Count | Charge Posting |
| Ins1 Amt | Insurance 1 Amount | Balance Control |
| Ins2 Amt | Insurance 2 Amount | Balance Control |
| Ins3 Amt | Insurance 3 Amount | Balance Control |
| Pat Amt | Patient Amount | Balance Control |
| Quad | Quadrant | Charge Posting |
| Tooth | Tooth Number | Charge Posting |
| Surface | Surface Identifier | Charge Posting |
| Form | Claim Form Used: 1500, UB, ADA | Service Items Library |
| RVU 1 | RVU 1 | Service Items Library |
| Work Total 1 | RVU 1 Total | Service Items Library |
| RVU 2 | RVU 2 | Service Items Library |
| Work Total 2 | RVU 2 Total | Service Items Library |
| RVU 3 | RVU 3 | Service Items Library |
| Work Total 3 | RVU 3 Total | Service Items Library |
| RVU 4 | RVU 4 | Service Items Library |
| Work Total 4 | RVU 4 Total | Service Items Library |
| RVU 5 | RVU 5 | Service Items Library |
| Work Total 5 | RVU 5 Total | Service Items Library |
| RVU 6 | RVU 6 | Service Items Library |
| RVU Total 6 | RVU 6 Total | Service Items Library |
| RVU 7 | RVU 7 | Service Items Library |
| RVU Total 7 | RVU 7 Total | Service Items Library |
| RVU 8 | RVU 8 | Service Items Library |
| RVU Total 8 | RVU 8 Total | Service Items Library |
| Department | Service Item Department | Service Items Library |
| Modality | Service Item Modality | Service Items Library |
| Component | Service Item Component: Global, Professional, Technical | Service Items Library |
| Place Of Serv | Place of Service | Charge Posting |
| Rv Cd | Service Item Revenue Code | Service Items Library |
| Aft Care | Service Item After Care Days | Service Items Library |
| Payer Name | Payer Name | Encounter Insurance |
| Fin Class | Financial Class | Payers Master File |
| Rendering | Charge Rendering provider | Charge Posting |
| Provider SubGrp 1 | Provider Subgrouping 1
| Providers Master File |
| Provider SubGrp 2 | Provider Subgrouping 2
| Providers Master File |
| Addtl Prov | Additional Provider
| Charge Posting |
| Admitting | Admitting Provider | Encounter Maintenance |
| Fst Consult | First Consulting Provider | Encounter Maintenance |
| Sec Consult | Second Consulting Provider | Encounter Maintenance |
| Referring | Encounter Referring Provider | Encounter Maintenance |
| Chg Referring | Charge Referring Provider | Charge Posting |
| Supervisor | Supervising Provider | Encounter Maintenance |
| Facility | Facility | Encounter Maintenance |
| Sts | Encounter/Charge Status (Abbreviated) | U/B/R/H/A |
| Status | Encounter Charge Status | Unbilled/Billed/Rebill/History/Bad Debt |
| Seq# | Charge Sequence Number | Charge Posting |
| Bt Info | Charge Batch Information | Charge Posting |
| RV Desc | RV Description | Service Items Library |
| Value Code | Value Code | The data populates from the Value Codes of the UB tab from the Encounter Maintenance. |
| Occur Code | Occurrence Code | The data populates from the Occurrence codes sub-tab of the UB tab from the Encounter Maintenance. |
| Pat Sts | Patient Status | |
| Pat Sts Rsn | Patient Status Reason | |
| Out | Outsource Indicator | Encounter Maintenance |
| Out Dt | Outsource Date | Encounter Maintenance |
| Out Agency | Outsource Agency | Encounter Maintenance |
| Client Def 1 - 14 | Enterprise Client Defined 1 - 14 Fields
| |
| Base Unit | Base Unit | Service Items Library |
| Beg Tm | Begin Time | Charge Posting |
| End Tm | End Time | Charge Posting |
| Tot Tm | Total Time | Charge Posting |
| Anesthesia Alt Code | Anesthesia Alternate Code | Service Items Library |
| Crt Dt | Create Date | Modification Information |
| Created By | Created By | Modification Information |
| Mod Dt | Last Modified Date | Modification Information |
| Modified By | Last Modified By | Modification Information |
| Diag1 Rsk Ind | Diagnosis 1 Risk Indicator | ICDCM Codes Master File |
| Diag2 Rsk Ind | Diagnosis 2 Risk Indicator | ICDCM Codes Master File |
| Diag3 Rsk Ind | Diagnosis 3 Risk Indicator | ICDCM Codes Master File |
| Diag4 Rsk Ind | Diagnosis 4 Risk Indicator | ICDCM Codes Master File |
| Homeless Status | Homeless Status | |
| Migrant Worker | Migrant Worker Status | |
| Language Barrier | Language Barrier | |
| Primary Medical | Primary Medical Coverage | |
| Race | Race | Patient Information
|
| Ethnicity | Ethnicity | Patient Information
|
| Tribal Affiliation | Tribal Affiliation | |
| Blood Quantum | Blood Quantum | |
| School Based Hlth Care | School Based Health Care | |
| Public Housing Primary | Public Housing Primary Care | |
| Veteran Status | Veteran Status | Patient Information |
| Descendancy | Descendancy | |
| IHS Eligibility Status | IHS Eligibility Status | |
| Classification/Beneficiary | Classification/Beneficiary | |
| Community Code | Community Code | Patient Information |
| Consent To Treat Ind | Consent To Treat Indicator | |
| Consent To Treat Date | Consent To treat Date | |
| Enc Homeless Status | Encounter Homeless Status | Encounter Maintenance |
| Prim Dental Prov Name | Primary Dental Provider Name | Patient Information |
| Race Category | Race Category | Race Category Mapping Master File
|
| Ethnicity Category | Ethnicity Category | Ethnicity Category Mapping Master File
|
Use columns to sub-total and total data on the report. Column total options include the following: