patient Claim / {{OrgName}}

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Rule Registration Details

ID	Rule Details

{{ruleItem.ID \|\| ''}}	{{ruleItem.RuleDetails \|\| ''}}
No rule details found.

Claim Details

Patient Details

Line Items

Claim Details

Patient Details

Line Items ({{ClaimItemsOriginal ? ClaimItemsOriginal.length : 0}})

Claim RefNumber

Claim Status

Claim ChangeStatus

Claim ChangeDateTime

CopiedTo ClaimsFinal

ClaimNotes

Facility ID

Claim Extract Run ID

Event

Message ID

Claim Number

Bill Date

Extract Date Time

Entered By

Patient FirstName

Patient LastName

Patient DOB

Patient Sex

Patient RefNumber

Patient MedRecordNbr

PatientID

LineItemNumber

OrderRefNumber

OrderItemRef

BillingDescription

InventoryType

ChargeCode

HCPCS

RXNumber

RefillNumber

NDC

Diagnosis1

Diagnosis2

Diagnosis3

Diagnosis4

AttendingDoctorId

Service From

Service To

Qty

Unit Retail

Hiclseqno

OrderTypeRef

Strength

Units

Description1

Strength Description

Per Unit Desc

Revenue Code

Billing Units

Inventory Ref

Quantity

Quantity Waste

Fill Qty

Diagnosis {{i}}

Audit Log

ID	Who	Event	Date

{{X.ID }}	{{X.Who}}	{{X.Event}}	{{X.Date}}