Service Item Summary - Transaction Source Report Columns
The following columns are available on the Service Item Summary - Transaction Source report:
| Column Name | Description | Data Populates From |
|---|---|---|
| Prac Name | Practice Name | Practice associated with the patient's encounter |
| Loc Name | Service Location Name | Encounter Maintenance |
| Location SubGrp 1 | Location Subgrouping 1
| Locations Master File |
| Location SubGrp 2 | Location Subgrouping 2
| Locations Master File |
| Encounter | Encounter Number | Encounter Maintenance |
| Rendering | Rendering Provider | Charge Posting |
| 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 |
| Admitting | Admitting Provider | Encounter Maintenance |
| Fst Consult | First Consulting Provider | Encounter Maintenance |
| Sec Consult | Second Consulting Provider | Encounter Maintenance |
| Enc Referring | Encounter Referring Provider | 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 |
| Supervisor | Supervising Provider | Encounter Maintenance |
| Facility | Facility | Encounter Maintenance |
| FQHC Qual Enc | FQHC Qualifying Encounter Indicator | |
| CCBHC Qual Enc | CCBHC Qualifying Encounter Indicator | |
| Pat Name | Patient Name | Patient Information |
| Per Nbr | Person Number | Patient Information |
| Addr1 | Line 1 of the patient mailing address | Patient Information |
| Addr2 | Line 2 of the patient mailing address | Patient Information |
| City | Patient city mailing address | Patient Information |
| State | Patient State mailing address | Patient Information |
| Zip | Patient Zip code | Patient Information |
| County | Patient county of residence | Patient Information |
| Sex | Sex at Birth | Patient Information |
| Birth Dt | Patient date of birth | 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 |
| Hm Phone | Home Phone | Patient Information |
| Day Phone | Day Phone | Patient Information |
| Alt Phone | Alternate Phone | Patient Information |
| Sec Hm Phone | Secondary Home Phone | Patient Information |
| Cell Ph | Cell Phone | Patient Information |
| Email Addr | Email Address | Patient Information |
| Md Rc | Medical Record Number | Patient Chart |
| Pat Type | Patient Type | Encounter Maintenance |
| Src Type | The Source Type can be:
| Charge Posting |
| Payer Name | Payer Name | Encounter Insurance |
| Prim Policy Number | Primary Policy Number | Encounter Insurance |
| Payer SubGrp 1 | Payer Subgrouping 1
| Payers Master File |
| Payer SubGrp 2 | Payer Subgrouping 2
| Payers Master File |
| Contracted Ind | Contracted Payer Indicator | Payers Master File |
| Sec Payer | Secondary Payer Name | Encounter Insurance |
| Sec Policy Number | Secondary Policy Number | Encounter Insurance |
| Tert Payer | Tertiary Payer Name | Encounter Insurance |
| Ter Policy Number | Tertiary Policy Number | Encounter Insurance |
| Fin Class | Financial Class | Payers Master File |
| 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 | Service Items Library |
| Rv Cd | Service Item Revenue Code | Service Items Library |
| Aft Care | Service Item After Care Days | Service Items Library |
| Sv It | Service Item Number | Charge Posting |
| Sv It Desc | Service Item Description | Charge Posting |
| Sv Type | Service Type | Encounter Maintenance |
| Modifier 1 | Charge Modifier 1 | Charge Posting |
| Modifier 2 | Charge Modifier 2 | Charge Posting |
| Modifier 3 | Charge Modifier 3 | Charge Posting |
| Modifier 4 | Charge Modifier 4 | Charge Posting |
| CPT4 | CPT 4 | Charge Posting |
| CPT4 Desc | CPT 4 Description | Charge Posting |
| 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 |
| Proc Dt | Process Date | Charge Posting |
| Event | Event Name | Appointment |
| Year | Year | YYYY |
| Month | Month | January - December |
| Mo/Year | Month and Year | Jan YYYY - Dec YYYY |
| Dt of Svc | The actual date of service | Charge Posting |
| End Dt of Svc | The end date of service | Charge Posting |
| Quad | Quadrant | Charge Posting |
| Tooth | Tooth Number | Charge Posting |
| Surface | Tooth Surface | Charge Posting |
| Bt Info | Charge Batch Information | Batch Maintenance |
| Form | Claim Form Used: 1500, UB, ADA | Service Items Library |
| Source | Source of Transaction | Transaction Detail |
| Adj Amt | Adjustment Amount | Transaction Detail |
| Pay Amt | Pay Amount | Transaction Detail |
| Refund Amt | Refund Amount | Transaction Detail |
| Ded Amt | The deductible the patient must pay according to their insurance plan. | Transaction Detail |
| Out | Indicates whether these charges have been outsourced for collections. | Patient Chart |
| Out Dt | The date that the charges were outsourced for collections. | Patient Chart |
| Out Agency | The collection agency that the debt was outsourced to. | Patient Chart |
| Client Def 1 - 14 | Enterprise Client Defined 1 - 14 Fields
| |
| Cost to Perform | The cost to perform the service. | Service Items Library |
| Sec Payer | Secondary Payer Name | Payers Master File |
| Tert Payer | Tertiary Payer Name | Payers Master File |
| 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 |
| Mrkt Plan Name | Marketing Plan Name | Encounter Maintenance |
| Mrkt Plan Type | Marketing Plan Type | Encounter Maintenance |
| Mrkt Desc | Marketing Plan Description | Encounter Maintenance |
| RVU 1 | Relative Value Unit 1 | Service Items Library |
| RVU Total 1 | Relative Value Unit Total 1 | Service Items Library |
| RVU 2 | Relative Value Unit 2 | Service Items Library |
| RVU Total 2 | Relative Value Unit Total 2 | Service Items Library |
| RVU 3 | Relative Value Unit 3 | Service Items Library |
| RVU Total 3 | Relative Value Unit Total 3 | Service Items Library |
| RVU 4 | Relative Value Unit 4 | Service Items Library |
| RVU Total 4 | Relative Value Unit Total 4 | Service Items Library |
| RVU 5 | Relative Value Unit 5 | Service Items Library |
| RVU Total 5 | Relative Value Unit Total 5 | Service Items Library |
| RVU 6 | Relative Value Unit 6 | Service Items Library |
| RVU Total 6 | Relative Value Unit Total 6 | Service Items Library |
| RVU 7 | Relative Value Unit 7 | Service Items Library |
| RVU Total 7 | Relative Value Unit Total 7 | Service Items Library |
| RVU 8 | Relative Value Unit 8 | Service Items Library |
| RVU Total 8 | Relative Value Unit Total 8 | Service Items Library |
| Diag 1 - 12 Cat | Diagnosis 1 - 12 Category | Diagnosis Categories Master File |
| Diag 1 - 12 SubGrp 1 | Diagnosis 1 - 12 Sub Grouping 1 | Diagnosis Codes Library |
| Diag 1 - 12 SubGrp 2 | Diagnosis 1 - 12 Sub Grouping 2 | Diagnosis Codes Library |
| Diag 1 - 12 Type | Diagnosis 1 - 12 Type | ICDCM Codes Master File |
| Diag 1 - 12 Risk Ind | Diagnosis 1 - 12 Risk Indicator | ICDCM Codes Master File |
| Pct Poverty | Percent of Poverty | Patient Information |
| Poverty Cat | Poverty Category | Patient Information |
| 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 | Patient Information |
| Consent to Treat Date | Consent to Treat Date | Patient Information |
| Enc Homeless Status | Encounter Homeless Status | Encounter Maintenance |
| Contracted Ind | Contracted Payer Indicator | Payers Master File |
| Prim Dental Prov Name | Primary Dental Provider Name | Patient Information |
| Prim Enc Rate SIM | Primary Rate SIM | Encounter Maintenance |
| Prim Enc Rate Amt | Primary Encounter Rate Amount | Encounter Maintenance |
| Sec Enc Rate SIM | Secondary Rate SIM | Encounter Maintenance |
| Sec Enc Rate Amt | Secondary Encounter Rate Amount | Encounter Maintenance |
| Ter Enc Rate SIM | Tertiary Rate SIM | Encounter Maintenance |
| Ter Enc Rate Amt | Tertiary Encounter Rate Amount | Encounter Maintenance |
| UD Price 1 | User Defined Price 1
| Service Items Library
|
| UD Price 2 | User Defined Price 2
| Service Items Library
|
| Rx | Rx Indicator | |
| Rental Ind | Rental Indicator | 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 |
| Dt Appl Placed | Date Appliance Placed | Encounter Maintenance |
| Demo Proj ID | Demonstration Project ID | The data populates from the Demonstaration Project ID field of the Claims tab on the Encounter Maintenance. |
| 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
|
|
| 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 |
| CPT EOC | CPT Episode of Care | CPT4 Codes Master File |
| Diag 1 - 12 EOC | Diag 1 - 12 Episode of Care | ICDCM Codes Master File |
| 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. |
| Chg Prog | The program assigned to a charge | Encounter Maintenance |