Claim Details Window Fields

Claim Details Field	Description
Insurance Co	Indicates the name of the patient’s insurance provider, to which the claim was billed. Note: When you hover over the primary insurance, it is Pri Ins ; for secondary, it is Sec Ins.
Date of Service	Indicates the date of service for the procedures represented in the claim.
Claim Status	Indicates the status of the selected claim. The statuses are: Sent Not Sent Partial Payment Received Closed
Claim Sent Type	Indicates the type of claim submitted to the carrier such as e-claim or paper claim.
Billing Order	Indicates the billing order established in the claim.
Total UCR	Indicates the Total UCR fee for all services. This includes all the insurance levels in the billing order. For instance, if you hover over the primary insurance and the billing order also includes a secondary insurance, then the total UCR fees is the sum of the fees for all the services in the primary and secondary insurances.
Total Billed	Indicates the total amount billed to all the insurances included in the billing order.
Pri Ins/Sec Ins/ Ter Ins/Qua Ins This indicates the level of the patient’s insurance coverage being viewed. All fields and their corresponding amounts in this section specific to the indicated insurance coverage level. For example, if the heading indicates Pri Ins, then all the fields in this section display amounts specific to the primary insurance of the patient. Similarly, if the insurance coverage level indicates Sec Ins, Ter Ins, or Qua Ins, all the fields with their corresponding amounts are specific to the indicated coverage level.
Note: The Other Ins section includes the sum of any other insurances which the patient may have for the given claim. The other sources include secondary, tertiary, and quaternary insurances.
Est Ins Portion	Displays the original amount estimated to be paid by the carrier for the procedures. It is always a positive amount.
Est Pat Portion	Displays the original amount estimated to be paid by the patient for the procedures. It is always a positive amount.
Ins Paid	Displays the total amount paid by the carrier to date for the claim. It is always a positive amount.
Ins Adjusted	Displays the amount adjusted in the insurance to date for the claim. This adjustment is the sum of all the debit adjustments and credit adjustments. Credits adjustments are positive amounts and debit adjustments are negative amounts.
Rem Ins Portion	Displays the remaining amount to be paid by the carrier for the claim. For a billing order with any unclosed claim, it is calculated as follows: Rem Ins Portion= Est Ins - Ins Paid - Ins Adjusted If all the claims in the billing order are closed, the amount of the Rem Ins Portion is transferred to the Rem Pat portion.
Patient Paid/Adj	Displays the total amount of patient payments and adjustments allocated to a claim. It is always a positive amount. Adjustments are the sum of all the debit and credit adjustments allocated to the claim. Credit adjustments are positive amounts and debit adjustments are negative amounts.
Rem Pat portion	Displays the remaining amount to be paid by the patient for the claim. For a billing order with any unclosed claim, it is calculated as Est Pat Portion - Patient Paid/Adj. If all the claims in the billing order are closed, the amount of the Rem Ins Portion is transferred to the Rem Pat Portion. Therefore, for a billing order with all claims closed, Rem Pat Portion = Est Pat Portion + Est Ins Portion - Ins Paid - Ins Adjusted - Patient Paid/Adj.

Insurance Co

Indicates the name of the patient’s insurance provider, to which the claim was billed.

Note: When you hover over the primary insurance, it is Pri Ins ; for secondary, it is Sec Ins.

Date of Service

Indicates the date of service for the procedures represented in the claim.

Claim Status

Indicates the status of the selected claim. The statuses are:

Sent
Not Sent
Partial Payment Received
Closed

Claim Sent Type

Indicates the type of claim submitted to the carrier such as e-claim or paper claim.

Billing Order

Indicates the billing order established in the claim.

Total UCR

Indicates the Total UCR fee for all services. This includes all the insurance levels in the billing order. For instance, if you hover over the primary insurance and the billing order also includes a secondary insurance, then the total UCR fees is the sum of the fees for all the services in the primary and secondary insurances.

Total Billed

Indicates the total amount billed to all the insurances included in the billing order.

Pri Ins/Sec Ins/ Ter Ins/Qua Ins

This indicates the level of the patient’s insurance coverage being viewed. All fields and their corresponding amounts in this section specific to the indicated insurance coverage level.

For example, if the heading indicates Pri Ins, then all the fields in this section display amounts specific to the primary insurance of the patient. Similarly, if the insurance coverage level indicates Sec Ins, Ter Ins, or Qua Ins, all the fields with their corresponding amounts are specific to the indicated coverage level.

Note: The Other Ins section includes the sum of any other insurances which the patient may have for the given claim. The other sources include secondary, tertiary, and quaternary insurances.

Est Ins Portion

Displays the original amount estimated to be paid by the carrier for the procedures. It is always a positive amount.

Est Pat Portion

Displays the original amount estimated to be paid by the patient for the procedures. It is always a positive amount.

Ins Paid

Displays the total amount paid by the carrier to date for the claim. It is always a positive amount.

Ins Adjusted

Displays the amount adjusted in the insurance to date for the claim. This adjustment is the sum of all the debit adjustments and credit adjustments. Credits adjustments are positive amounts and debit adjustments are negative amounts.

Rem Ins Portion

Displays the remaining amount to be paid by the carrier for the claim. For a billing order with any unclosed claim, it is calculated as follows:

Rem Ins Portion= Est Ins - Ins Paid - Ins Adjusted

If all the claims in the billing order are closed, the amount of the Rem Ins Portion is transferred to the Rem Pat portion.

Patient Paid/Adj

Displays the total amount of patient payments and adjustments allocated to a claim. It is always a positive amount.

Adjustments are the sum of all the debit and credit adjustments allocated to the claim. Credit adjustments are positive amounts and debit adjustments are negative amounts.

Rem Pat portion

Displays the remaining amount to be paid by the patient for the claim. For a billing order with any unclosed claim, it is calculated as Est Pat Portion - Patient Paid/Adj. If all the claims in the billing order are closed, the amount of the Rem Ins Portion is transferred to the Rem Pat Portion. Therefore, for a billing order with all claims closed,

Rem Pat Portion = Est Pat Portion + Est Ins Portion - Ins Paid - Ins Adjusted - Patient Paid/Adj.