The Supplemental Information section displays additional information relating to the claim. The Supplemental Information fields are defined by section below:
Service Line Additional Supplemental Information
Line Item Ctrl NbrLine Item Ctrl Nbr
Identifier assigned by the submitter/provider to this line item. When keying a new claim, this field populates once a claim is saved.
Required if sales tax applies to the service line and the submitter is required to report that information to the receiver.
Service Line Prior Authorization, Referrals, and Predeterminations
Prior Authorization NbrPrior Authorization Nbr
A number or other indicator that designates that the treatment covered by this bill has been authorized by the payer.
Reference information as defined for a particular transaction set or as specified by the reference identification qualifier. Available for primary, secondary, and tertiary numbers.
PredeterminationPredetermination
Identifier assigned to a predetermination of benefits. Available for primary, secondary, and tertiary numbers.
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