Tip: Some of the information displayed on this page is read-only and cannot be changed.Use this page to enter a service line item for a claim.
Tip: Some of the information displayed on this page is read-only and cannot be changed.
The following information on this page is read-only and cannot be changed:
Service Line displays the application-generated line item number for the service line.
Unit Conversion displays the current unit conversion where 1 unit equals 15 minutes of service time.
Complete the following information to enter a service line for the claim:
In Service Date, enter the date on which the service was purchased.
In Place of Service, select the location of service for the service line.
Select the Second Service for the Same Date check box to indicate that this service was performed twice on the same day.
EI Code displays the EI Code for the authorization. This information is read-only and cannot be changed.
In CPT, enter the CPT code for the service line. You can click the 
icon to search for a specific CPT, then select a specific CPT in the Select CPT table.
Enter the ICD9 Code for the service line. You can click the icon to search for a specific ICD9, then select a specific ICD9 in the Select ICD9 Code table.
In Units, enter the total number of units charged for the service line. You can enter up to 4 numeric digits in this text box. 1 unit equals 15 minutes of service time.
In Charges $, enter the total dollar amount charged for the service. You can enter up to 7 numeric digits in this text box.
Click the following button(s) as necessary:
Click Reset to clear any unsaved changes and restore the previously displayed information.
Click Close to return to the previous page.
Click Add to Claim to save any information that was entered on this page.
Click the following link(s) to see how to complete a task step-by-step: