<practice name> Transaction Report

Run Date: <system date>

Selections:

Patient Chart: <from patient> - <to patient>

Patient Type: <from patient type> - <to patient type>

Insurance Code: <from insurance code> - <to insurance code>*

Billing Numbers: <from bill number> - <to bill number>

Service Dates: <from service date> - <to service date>

Sort by:

Subtotal by:

Level:

* Choose the bill if either the primary or secondary insurance on the bill header matches the insurance code chosen

** For all selections, leaving blank means selecting all.

<practice name> Transaction Report as of <system date>

Procedure Level

* Show provider code and name for each section if subtotal by provider and show location code and name for each section if subtotal by location

Chart Patient Name Bill # Svc Date CPT Charge Paid Pay/Adj Date Pay/Adj Code

<chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total paid**> <pay/adj amt>< pay/adj date> < pay/adj code>

<chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total paid**> <pay/adj amt>< pay/adj date> < pay/adj code>

<chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total paid**> <pay/adj amt>< pay/adj date> < pay/adj code>

Bill Totals for <billno>: Charge: <bill charge> Paid: <bill paid> Adj: <bill adjusted> Owed: <bill owed>

Patient Totals for <chart>: Charge: <bill charge> Paid: <bill paid> Adj: <bill adjusted> Owed: <bill owed>

Location or Provider totals for <loc or prov>:

Charge: <bill charge> Paid: <bill paid> Adj: <bill adjusted> Owed: <bill owed> Num of bills: <count***>

Report totals for:

Charge: <bill charge> Paid: <bill paid> Adj: <bill adjusted> Owed: <bill owed> Num of bills: <count***>

* Use the cpt code for charges and the transaction code for all else.

** total paid for a line will require accumulation of the payment amount from payment transactions in the payment file

** payments which are not applied to a particular line will appear as their own lines, while those applied will not appear

*** Program will count the transactions. This count refers to number of bills.

Any data in the <chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total paid**> < pay date> < pay code> will not be repeated if the info before it is the same.

Sort by patient chart or name, depending upon the sort selected.

<practice name> Transaction Report as of <system date>

Bill Level

* Show provider code and name for each section if subtotal by provider and show location code and name for each section if subtotal by location

Chart Patient Name Bill # Svc Date CPT Charge Primary Paid Secondary Paid Adjusted Owed

<chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total primary paid**> <total secondary paid> <total adj****> < total owed>

Bill Totals for <billno>: <bill charge> <bill prim paid> <bill sec paid> <bill adjusted> <bill owed>

Patient Totals for <chart>: <bill charge> <bill prim paid> <bill sec paid> <bill adjusted> <bill owed> <count***>

Location or Provider totals for <loc or prov>:

<bill charge> <bill prim paid> <bill sec paid> <bill adjusted> <bill owed> <count***>

Report totals for:

<bill charge> <bill prim paid> <bill sec paid> <bill adjusted> <bill owed> <count***>

* Use the cpt code for charges and the transaction code for all else.

** total paid for a line will require accumulation of the payment amount from payment transactions in the payment file

** payments which are not applied to a particular line will appear as their own lines, while those applied will not appear

*** Program will count the transactions. This count refers to number of bills.

****Include everything but primary and secondary payment in bill adjusted so total charge - (prim paid + sec paid + bill adj) = bill owed.

Any data in the <chart> <pat last + first initial > <bill no> <service date> < cpt*> <charge> <total paid**> < pay date> < pay code> will not be repeated if the info before it is the same.

Sort by patient chart or name, depending upon the sort selected.