Tip: Some of the information displayed on this page is read-only and cannot be changed.Use this page to enter a transportation 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:
Transportation Line displays the application-generated line item number for the transportation line.
Unit Conversion displays the current unit conversion where 1 unit equals 1 mile or 1 trip.
Complete the following information to enter a transportation line for the claim:
In Travel Date, enter the date on which the travel occurred. This is required information.
Select the Second Transportation Service for the Same Date check box to indicate that this transportation service was performed twice on the same day.
In EI Code, view the EI Code for the authorization. This information cannot be changed.
In CPT, enter the CPT code for the transportation line. This is required information.
In Units, enter the total number of units charged for the transportation line. You can enter up to 4 numeric digits in this text box. 1 unit equals 1 mile or 1 trip. This is required information.
In Charges $, enter the total dollar amount charged for the service. You can enter up to 9 numeric digits in this text box. This is required information.
In the Select CPT table, select a CPT to insert for the transportation line.
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: