Service Line Details
Service Line DetailsEach service line on an Institutional Claim will have information available in addition to what is displayed in summary on the main page. This information is accessed by clicking the More icon on the main Service Line(s) page.
The top of the screen will display information on what service line more button you are on. This includes, Line Number, Line Item CTL #, DOS, Rev Code, Proc & Mod, Charge Amount and Service Count that was enter on the service line.
If any information is entered into this section, all pieces of data must be populated.
National Drug Code: Enter the NDC for the drug associated with this Service Line. The value entered must be 11 digits with no hyphens.
National Drug Unit Count: Enter the number of units dispensed of this medication. Also, select the proper Unit of Measure to be associated with this value. Defaults to 'Unit' but any valid value may be selected.
Pharmacy Prescription Number/Link Sequence Number: Pick whether you are entering a Prescription Number or Link Sequence Number.
Prescription/Compound Number(s): The Prescription/Compound Number associated with the drug may be entered here.
Other Payer Name: Select the name of the desired payer from the provided list.
Service Line Paid Amount: The dollar amount paid by the Payer towards this service line.
Paid HCPCS Code: The HCPCS code paid by the other payer.
Modifiers: The modifiers associated with the HCPCS above paid by the other payer.
Paid Service Unit Count: The amount of service units paid by the other payer.
Bundled Line Number: If applicable, enter the number of the line bundled or unbundled by the other payer.
Date Claim Paid: Date on which the Other Payer Paid Amount was received. This date may not be greater than the current date. The format is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field.
Remaining Patient Liability: This is the amount the provider believes is due and owing after the Other Payer’s adjudication.
Claim Adjustment Group: Enter the Group Code as received from the other payer. The general category of the payment adjustment. A maximum of 5 Claim Adjustment Groups are allowed per claim and the values are to be entered.
Reason Code: Enter the Claim Adjustment Reason Code as received from the other payer. This is directly correlated to the Claim Adjustment Group. The Claim Adjustment Group/Reason Code combination may not be entered more than once. If an Adjustment Amount or Adjustment Quantity is entered, a Reason Code is required.
Adjustment Amount: Enter the Adjustment Amount as received from the other payer. An Adjustment Amount is required when a Reason Code is entered.
Adjustment Quantity: Enter the Quantity Adjusted as received from the other payer.
If Other Payers have been included on the claim and they have adjudicated this line or you need to maintain the adjudication details, you may view/maintain the individual Line Adjudication Information or view a summary of all adjudication information for this line.
Click here for the controls located at the bottom of the page.
