.
An asterisk (*) following the field name indicates a Required field in the Core SmartCare system. Your system may have been customized to require additional fields.
Field |
Description |
Claim |
|
Provider Number |
Identifies the provider number assigned to the provider by the MCO. This may be the organization providing the service or the individual provider. |
Provider Name |
Identifies the provider's name. |
Tax ID |
Identifies the provider's tax ID number. |
Provider NPI |
Identifies the provider's National Provider Identification number. |
Provider Taxonomy Code |
Identifies the taxonomy code assigned to the provider to indicate provider type and area of specialization. |
Control Number |
Identifies the number assigned by the system to this claim. |
Subscriber Number |
identifies the subscriber's coverage number. |
Last Name |
Identifies the subscriber's last name. |
First Name |
Identifies the subscriber's first name. |
Acct # |
Identifies the subscriber's coverage account number. |
Payer ID |
Identifies the coverage payer's ID number. |
Claim Control # |
Identifies the number assigned to this claim. |
Charges |
Identifies the dollar amount of the claim. |
Claim Line |
|
Claim Line ID |
Identifies the number assigned to this line in the claim. |
Service Line # |
Identifies the number assigned to each line in the service. |
Line Item Control Number |
Identifies control number assigned to the service line to identify it is included in this claim. |
Date of Service |
Identifies the client's date of service. |
Revenue Code |
Identifies the revenue code assigned to the service. |
Procedure Code |
Identifies the procedure code assigned to the service. |
Authorization # |
Identifies the authorization number assigned to the service indicating that the plan provided authorization for the service. |
Charges |
Identifies the dollar amount for this procedure code. |
Rendering Provider |
|
Provider Number |
Identifies the provider who provided the service for the organization. |
Provider Name |
Identifies the name of the rendering provider. |
Tax ID |
Identifies the rendering provider's tax ID. |
Provider NPI |
Identifies the rendering provider's NPI. |
Provider Taxonomy Code |
Identifies the rendering provider's taxonomy code. |
Errors |
|
Error Code |
If any errors are found when the claim is processed, the code is displayed in this field. |
Error Description |
If any errors are found when the claim is processed, the description of the code is displayed. |