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Unpaid Claims Report Sample

The Unpaid Claims Report ists all unpaid insurance claims and their associated details for you to use when following up with the insurance carrier.

Tips:

• To see instructions for running the report shown below, see the Unpaid Claims Report Instructions.

• To see descriptions of the report fields, click More.

   

  Unpaid Claims Report Fields Tip:  To see more information about a field, click the hyperlink for the field name.
  ACCT#	Patient account number
  GUARANTOR/PATIENT	Guarantor's last name, first name
  TKT# /	Unpaid charge ticket number
  DR	Provider code
  SVC DATE	Service date of charge
  DIAGNOSIS	Diagnosis Code for unpaid charge
  PROCEDURE	Procedure associated with the unpaid charge
  CHRGS	Charge dollar amount for the unpaid claim
  ADJSTS	Charge adjustment dollar amount for the unpaid claim
  NET	Balance of dollars owed for unpaid claim
  BILL DATE	Date the charge is billed
  STAT	Charge's bill status
  RESP	Charge's responsibility code
  INSUR	Insurance Code assigned to charge
  AGE	Age of charge
  LINE 2
  Patient Name	Patient's Last name, First name
  CERT. GROUP	Patient's policy holder insurance certificate number or group number
  MEMBER DOB	The guarantor's date of birth
  PMT DATE	Date of the payment for the charge
  PYMT TRANSACTION	Transaction description associated with the payment
  PYMTS	Payment dollar amount for charge