New Professional Claim
Required fields are minimal so you can generate quickly. Patient, payer and provider dropdowns pull directly from your master tables.
Patient & Member
Payer
Rendering Provider
Diagnoses
Up to 4 ICD-10 codes.
Service Lines
Total Charge:
$0.00
| # | CPT | Units | $Charge | POS | Mod1 | Mod2 | Rendering Override |
|---|---|---|---|---|---|---|---|
| 1 | |||||||
| 2 | |||||||
| 3 | |||||||
| 4 | |||||||
| 5 | |||||||
| 6 |