Loading...
Loading...
This report contains fields that can be identified as Protected Content in Enterprise Preferences. These fields identify a patient's sexual orientation and gender identity (SOGI). If any of these fields are identified as protected content fields, then you must have the appropriate security access rights to view the data in these fields.
| Column Name | Description | Data Populates From |
|---|---|---|
| Prac Name | Practice Name | Practice associated with the patient's encounter |
| Loc Name | Service Location Name | Encounter Maintenance |
| Created By | User that created the report | Modified Information |
| Type Desc | Type of Activity Description | Encounter Maintenance |
| Location SubGrp 1 | Location Subgrouping 1
| Locations Master File |
| Location SubGrp 2 | Location Subgrouping 2
| Locations Master File |
| Loc Addr 1 | Location Line 1 of mailing address | Locations Master |
| Loc Addr 2 | Location Line 2 of mailing address | Locations Master |
| Loc City | Location mailing address city | Locations Master |
| Loc State | Location mailing address state | Locations Master |
| Loc Zip | Location mailing Zip code | Locations Master |
| Loc Phone | Location phone number | Locations Master |
| Post Date | Date the charges from that date posted | Transaction Detail |
| Proc Date | Process Date | Charge Posting |
| Ovr Proc Dt | Override Process Date | Charge Posting |
| E/I/A/B |
| Transaction Detail |
| Dtl E/I/A/B | Details for:
| Transaction Detail |
| Account Nbr | Account Number | Account Profile |
| Src Type | Source Type
This can be one of the following:
| Encounter or Invoice |
| Name | Name of patient | Patient Information |
| Per Nbr | Person Number | Patient Information |
| City | Patient city of residence | Patient Information |
| Zip | Patient mailing zip | Patient Information |
| County | Patient county of residence | Patient Information |
| Sex | Sex at Birth | Patient Information |
| Birth Dt | Date of Birth | Patient Information |
| Pat Age | Patient Age | Patient Information |
| Insured Name | Insured Name | Patient Information |
| Pat Type | Patient Type | Encounter Maintenance |
| Amount | Price of the SIM | Service Items Library |
| Aprv Amt | Approved Amount | Service Items Library |
| Alwd Amt | Allowed Amount | Contract Library |
| Billed Amount | Billed Amount | Financial tab in the Patient Chart |
| Tran Date | Transaction Date | Batch Maintenance |
| Tran Cd | Transaction Code | Batch Maintenance |
| Bt Dt | The date that the batch was created. | Batch Maintenance |
| Bt Nbr | Batch number | Batch Maintenance |
| Bt Desc | The description entered for tracking the batch. | Batch Maintenance |
| Track Desc | The description entered for tracking the batch. | Batch Maintenance |
| Tran Status | The status of the transaction | Batch Maintenance |
| Rsn Cds | Reason Codes | Reason Code Library |
| Ded Amt | The deductible amount payable by the patient | Payers Master File |
| Source | This is an adjustment source pulling from either:
| Payment Entry |
| Dt of Svc | Date of Service | Encounter Maintenance |
| End Dt of Svc | End Date of Service | Encounter Maintenance |
| CPT4 | The CPT4 code attached to the charge. | Service Items Library |
| CPT4 Desc | The description of the CPT4 code. | Service Items Library |
| Sv It | This is the Service Item attached to the charge. This can include a CPT4 code. The Service Item is created by the system administrator. | Service Items Library |
| Sv It Desc | The is a description of the Service Item. | Service Items Library |
| Sv Type | Service Type | Encounter Maintenance |
| Modifier 1 | Charge modifier 1 | Service Items Library |
| Modifier 2 | Charge modifier 2 | Service Items Library |
| Modifier 3 | Charge modifier 3 | Service Items Library |
| Modifier 4 | Charge modifier 4 | Service Items Library |
| COB1 Amt | This is the Coordinated benefits primary payment amount. | Balance Control |
| COB2 Amt | This is the Coordinated benefits secondary payment amount. | Balance Control |
| COB3 Amt | This is the Coordinated benefits tertiary payment amount. | Balance Control |
| Pat Amt | Patient Amount | Balance Control |
| Ln Itm Amt | The encounter can have several charges that compromise the entire charge for the encounter. The Line Item Amount breaks the charges down by line item per service. | Charge Posting or Transactions tab in the Patient Chart |
| Bad Debt | The actual amount of bad debt carried by this patient displays in this column. | Financial tab in the Patient Chart |
| Self Less Bad Debt | Amount billed to patient, less any bad debt amount. | Financial tab in the Patient Chart |
| Chg Amt | This is the actual amount of the charge. | Charge Posting |
| Unit Price | Service Items charges are defined on a per unit basis. This field displays the unit price for the Service Item. | Service Items Library |
| Count | Number of units for this encounter. | Charge Posting |
| Ovr | Displays whether the process date was overridden. | Transaction Detail |
| Diag 1 - 12 | Diagnosis Code 1 - 12 | Charge-Level: Codes 1-4 Encounter-Level: Codes 5-12 |
| Diag 1 - 12 Desc | Diagnosis 1 - 12 Description | Diagnosis Codes 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 Service | The actual location the service was rendered. | Charge Posting |
| Place of Service Code | The code for the service location. | Places of Service Code Table |
| RV Code | Service Item Revenue Code | Service Items Library |
| Aft Care | Service Item After Care Days | Service Items Library |
| Payer Name | The name of the patient payer. | Payers Master File |
| Fin Class | Financial Class | Payers Master File |
| Notes | Displays whether there are any notes attached to the patient's chart. | Notes tab on the Patient Chart |
| Void | This indicates whether this encounter and all its charges were voided or not. | Encounter Maintenance |
| Rendering | Rendering Provider | Chart Details sub tab of the Patient Information tab of the Patient Chart |
| Enc Rendering | Encounter Rendering Provider | Encounter Maintenance |
| 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 |
| Enc Referring | Encounter Referring Providers | Encounter Maintenance |
| Enc Referring Addr 1 | Referring Provider Address Line 1 | Providers Master File |
| Enc Referring Addr 2 | Referring Provider Address Line 2 | Providers Master File |
| Enc Referring City | Referring Provider City | Providers Master File |
| Enc Referring State | Referring Provider State | Providers Master File |
| Enc Referring Zip | Referring Provider Zip Code | Providers Master File |
| Enc Referring County | Referring Provider County | Providers Master File |
| Chg Referring | Charge Referring Provider | Charge Posting |
| Referring UPIN# | Referring Unique Provider ID Number | Providers Master File |
| Supervisor | Supervising Provider | Encounter Maintenance |
| Onset Dt | The date that the ailment, illness, or injury began. | Encounter Maintenance |
| Onset Tm | The time the ailment, illness, or injury began. | Encounter Maintenance |
| Status | The status of the encounter's charges. | Claim Request Lookup |
| RV Desc | Revenue Description | Service Items Library |
| Value Code | Value Code | Sub-Tab |
| Occur Code | Occurrence Code | Sub-Tab |
| Pat Sts | Patient Status | Patient Information |
| Pat Sts Rsn | Patient Status Reason | Patient Information |
| FQHC Qual Enc | FQHC Qualifying Encounter Indicator | |
| CCBHC Qual Enc | CCBHC Qualifying Encounter Indicator | |
| Out | Whether this patient balance is out for collections or not. | Patient Chart |
| Out Date | The date that this patient balance was sent to the collection agency. | Patient Chart |
| Out Agency | The name of the collection agency. | Patient Chart |
| Client Def 1 - 14 | Enterprise Client Defined 1 - 14 Fields
| |
| Base Unit | Unit associated with an Anesthesia SIM. | Service Items Library |
| Beg Time | The beginning time of the service. | Charge Posting |
| End Time | The ending time of the service. | Charge Posting |
| Tot Time | The total amount of time that the patient spent at the practice, from check-in to check-out. | Charge Posting |
| Alt Code | If you have set up an alternative code for a CPT4 code in the SIM library, it displays here. An alternative code could easily be a CPT4 for inpatient versus outpatient services. The same service is rendered, but you need to differentiate between where it was performed. The Alternate Code is set up and defined in the SIM library. | Charge Posting |
| Quad | Mouth Quadrant | Charge Posting |
| Tooth | Tooth Number | Charge Posting |
| Surface | Surface Identifier | Charge Posting |
| Form | Claim Form to Use: 1500, UB, ADA | Service Items Library |
| Narrative | The narrative is user-entered text describing or explaining some aspect of the SIM. You can find this field on the Narrative tab of the SIM in the SIM Library. | Charge Posting |
| Crt Dt | Create Date | Modification Information |
| Modified Dt | Last Modified Date | Modification Information |
| Modified By | Last Modified By | Modification Information |
| Facility | Facility | Encounter Maintenance |
| Addr1 | Line 1 of the patient mailing address. | Patient Information |
| Addr2 | Line 2 of the patient mailing address. | Patient Information |
| State | The patient state of residence. | Patient Information |
| SSN # | Social Security Number | Patient Information |
| Md Rc | Medical Record Number | Patient Chart |
| Hm Phone | Home Phone | Patient Information |
| Employer Desc | A description of the patient employer | Patient Information |
| Guar Name | The patient financial guardian's name | On the Relationship/Contact/Guar tab of the Patient Chart |
| Guar Addr1 | Line 1 of the Guarantor's mailing address | Modify Guardian Information |
| Guar Addr2 | Line 2 of the Guarantor's mailing address | Modify Guardian Information |
| Guar State | The Guarantor's state address | Modify Guardian Information |
| Guar City | The guardian's city address | Modify Guardian Information |
| Guar Zip | The Guarantor's mailing Zip code | Modify Guardian Information |
| Guar Phone | The Guarantor's phone number | Modify Guardian Information |
| Guar Employer | The Guarantor's employer | Modify Guardian Information |
| Guar Relationship | The relationship of the Guarantor to the patient. | Modify Guardian Information |
| Primary Ins Name | The primary insurance company name | Insurance Maintenance |
| Primary Ins Addr1 | Line 1 of the primary insurance company's address | Insurance Maintenance |
| Primary Ins Addr2 | Line 2 of the primary insurance company's address | Insurance Maintenance |
| Primary Ins City | Primary insurance city address | Insurance Maintenance |
| Primary Ins State | Primary insurance state address | Insurance Maintenance |
| Primary Ins Zip | Primary insurance Zip code | Insurance Maintenance |
| Primary Ins Grp Name | Primary insurance group name | Insurance Maintenance |
| Primary Ins Grp # | Primary insurance group number | Insurance Maintenance |
| Primary Pol # | Primary insurance policy number | Insurance Maintenance |
| Primary Ins Subscriber Name | Primary insurance subscriber name; the person the policy is listed under | Insurance Maintenance |
| Primary Ins Subscr Relationship | Primary insurance subscriber's relationship to the patient | Insurance Maintenance |
| Second Ins Name | Secondary insurance company name | Insurance Maintenance |
| Second Ins Addr1 | Line 1 of secondary insurance's mailing address | Insurance Maintenance |
| Second Ins Addr2 | Line 2 of secondary insurance's mailing address | Insurance Maintenance |
| Second Ins City | Secondary insurance city of mailing address | Insurance Maintenance |
| Second Ins State | Secondary insurance state of mailing address | Insurance Maintenance |
| Second Ind Zip | Zip code of secondary insurance mailing address | Insurance Maintenance |
| Second Ins Grp Name | Secondary insurance's group name | Insurance Maintenance |
| Second Ins Grp # | Secondary insurance's group number | Insurance Maintenance |
| Second Pol # | Secondary insurance policy number | Insurance Maintenance |
| Second Ins Subscr Name | Secondary insurance subscriber's name | Insurance Maintenance |
| Second Ins Subscr Relationship | Secondary insurance subscriber's relationship to the patient | Insurance Maintenance |
| Provider Addr1 | Line 1 of the Provider's mailing address | Providers Master File |
| Provider Addr2 | Line 2 of the Provider's mailing address | Providers Master File |
| Provider City | Provider's city mailing address | Providers Master File |
| Provider State | Provider's state mailing address | Providers Master File |
| Provider Zip | Provider's Zip code for mailing address | Providers Master File |
| Provider Phone | Provider's phone number | Providers Master File |
| Provider # | Provider's identification number | Providers Master File |
| Provider Tax ID | Provider's tax identification number | Providers Master File |
| Provider CLIA | The Clinical Laboratory Improvement Amendments (CLIA) number of the provider. CLIA numbers can be linked at the SIM and Provider levels as well as the Facility and Service Location levels. | Providers Master File |
| Type of Service |
| Encounter Maintenance |
| Service Auth # | The authorization code from the insurance company for approved services. | Encounter Maintenance |
| Sec Payer | Secondary Payer Name | Payers Master File |
| Tert Payer | Tertiary Payer Name | Payers Master File |
| Pat Prov UD 1 - 12 | Patient Provider User Defined 1 - 12 Fields
| |
| 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 |
| Diag 1 - 12 Cat | Diagnosis 1 - 12 Category | Diagnosis Categories Master File |
| Diag 1 - 12 SubGrp 1 | Diagnosis Sub1 Grouping 1 | Diagnosis Codes Library |
| Diag 1 - 12 SubGrp 2 | Diagnosis Sub2 Grouping 2 | Diagnosis Codes Library |
| Diag 1 - 12 Type | Diagnosis 1 - 12 Type | ICDCM Codes Master File |
| RVU 1 | RVU 1 | Service Items Library |
| RVU Total 1 | RVU 1 Total | Service Items Library |
| RVU 2 | RVU 2 | Service Items Library |
| RVU Total 2 | RVU 2 Total | Service Items Library |
| RVU 3 | RVU 3 | Service Items Library |
| RVU Total 3 | RVU 3 Total | Service Items Library |
| RVU 4 | RVU 4 | Service Items Library |
| RVU Total 4 | RVU 4 Total | Service Items Library |
| RVU 5 | RVU 5 | Service Items Library |
| RVU 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 |
| Mrkt Plan Name | Marketing Plan Name | Encounter Maintenance |
| Mrkt Plan Type | Marketing Plan Type | Encounter Maintenance |
| Mrkt Desc | Marketing Plan Description | Encounter Maintenance |
| Homeless Status | Homeless Status | Patient Information |
| Migrant Worker Status | Migrant Worker Status | Patient Information |
| Language Barrier | Language Barrier | Patient Information |
| Primary Med Cov | Primary medical Coverage | Patient Information |
| Race | Race | Patient Information
|
| Ethnicity | Ethnicity | Patient Information
|
| Tribal Affiliation | Tribal Affiliation | Patient Information |
| Blood Quantum | Blood Quantum | Patient Information |
| Veteran Status | Veteran Status | Patient Information |
| School Based Hlth Care | School Based Health Care | Patient Information |
| Public Housing Primary | Public Housing Primary Care | Patient Information |
| Descendancy | Descendancy | Patient Information |
| IHS Eligibility Status | IHS Eligibility Status | Patient Information |
| Classification Beneficiary | Classification Beneficiary | Patient Information |
| 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 |
| Prim Enc Rate SIM | Primary Encounter Rate Service Item | Encounter Maintenance |
| Prim Enc Rate Amt | Primary Encounter Rate Amount | Encounter Maintenance |
| Sec Enc Rate SIM | Secondary Encounter Rate Service Item | Encounter Maintenance |
| Sec Enc Rate Amt | Secondary Encounter Rate Amount | Encounter Maintenance |
| Ter Enc Rate SIM | Tertiary Encounter Rate Service Item | Encounter Maintenance |
| Ter Enc Rate Amt | Tertiary Encounter Rate Amount | Encounter Maintenance |
| Rx | Rx Indicator | Charge Posting |
| Dt Appl Placed | Date Appliance Placed | Encounter Maintenance |
| Bad Amt | Charges-Adjustments-Payments-Refunds Amt | Encounter Maintenance |
| Chg-Adj Amt | Charges-Adjustments Amount | Encounter Maintenance |
| NDC | National Drug Code | Charge Posting |
| NDC Basis of Measure | NDC Basis of Measure | Charge Posting |
| Drug Count | National Drug Units | Charge Posting |
| Gender Identity | Patient Gender Identity | Patient Information
|
| Sexual Orientation | Patient Sexual Orientation | Patient Information In Enterprise Preferences, if this field is selected as Protected Content, then you must have the applicable security access rights to view the data in this field. |
| Preferred Pronoun | Preferred Gender Pronoun | Patient Information In Enterprise Preferences, if this field is selected as Protected Content, then you must have the applicable security access rights to view the data in this field. |
| Current Gender | Current Gender | Patient Information In Enterprise Preferences, if this field is selected as Protected Content, then you must have the applicable security access rights to view the data in this field. |
| Race Category | Race Category | Race Category Mapping Master File
|
| Ethnicity Category | Ethnicity Category | Ethnicity Category Mapping Master File
|
| Test Date | Test Date
| |
| Qualifier/Test Name | Qualifier/Test Name
|
|
| Test Result | Test Result
|
|
| CPT EOC | CPT Episode of Care | CPT4 Codes Master File |
| Diag 1 - 12 EOC | Diag 1 - 12 Episode of Care | ICDCM Codes Master File |
| APG Code | APG Code | |
| Rate Code | APG Rate Code | |
| Pmt % | APG Payment Percentage | |
| Weight | APG Weight | |
| Add-On | APG Add-On Amount | |
| Expected Reimb Amt | APG Expected Reimbursement Amount | |
| Message | APG Message | |
| APG Date | APG Response Date | |
| Chg Ordering | Charge Ordering Provider | Charge Posting |
| Enc Ordering | Encounter Ordering Provider | Encounter Maintenance |
| APC Payment | APC Payment
| Displays Y for credit card payments processed via InstaMed on accounts that are enabled for APC. |
| Gateway ID | Gateway ID
| Displays the Gateway ID used for credit card payments processed via TSYS-Express. |
| Admitting DX | Admitting Diagnosis | Encounter Diagnosis Selection |
| Outlet ID | Outlet ID The Outlet ID is the name of the outlet as identified in the Description column in on the InstaMed Configuration window. | Displays the name of the Outlet ID selected when processing a payment for InstaMed. |