Claims Detail Report Sample Clauses

Claims Detail Report. Alphabetical by patient name including date of birth; claim number;

Claims Detail Report. Alphabetical by patient name including date of birth; claim number; referral source; chart number; provider name; service type; date of service; length of stay, if applicable; amount billed, paid, and disallowed; International Statistical Classification of Diseases and Related Health Problems, ninth edition (ICD9) and Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes; description of ICD9 and CPT/HCPCS codes. (Monthly and Cumulative Year-to-Date) Claims Summary Report: By referral source and grand total: number of inpatient days and amount paid; number of physician service days and amount paid; and number of outpatient service days and amount paid. (Monthly) Claim Status Report: Alphabetical by patient name including date of birth; claim number; service type; date received; date adjudicated; claim status (pended, paid, denied); date paid; and processing time. (Monthly) Claim Status Summary Report: By month claim received (12-month period); number of claims received; number of claims rejected; number of claims in process; number of claims paid; number of claims denied: total claims finalized; percent claims processed; and grand totals, 12-month averages, and percentage of claims received for previous variables. (Monthly)

Claims Detail Report. Alphabetical by patient name including 4 date of birth; claim number; referral source; chart number; provider name; service type; date of service;