The Service Lines section displays information regarding to the various service providers on a line level. This section includes information on the following:
Click Add Line to add service line details to the table. This also populates the additional tabs at the bottom of the screen. Once a line is added, the user can select a line to copy and click Copy Line. This creates an exact duplicate of the current line and populates it after the last service line in the claim. A prompt displays asking the user whether to copy the line level detail. If yes, the entire line with service line details is copied. If no, only the line level detail is copied – no service line detail information is copied
Up to six (6) Diagnosis Codes can be viewed at a time. Click (+) to add up to six (6) more codes.
Click the Service Line Details link to display the section menu. Click the desired section name to display the fields to the right of the menu. Enter the information in the Service Lines Details fields and click Save in the tool bar. The entered data populates in the table. A message displays if a change is made to the service line, but the user deselects the line without saving. Click OK to continue. Click Delete to remove a service line. Ten (10) lines display at a time, but up to 50 service lines can be added. An alert message displays if the user attempts to add more than 50 service lines. If a claim is imported with more than 50 service lines, it is errored for exceeding the line limit for professional claims.
Service Line Details: This section displays the claim service line items after adjudication. Any adjustments to the claim amount versus the amount paid are detailed here. The information on this screen comes from an 835 Remittance Advice returned by an insurer/payer.
Start of service dates for treatment or service listed on this service line.
Ending date of service for the treatment or service listed on this service line.
Place of ServicePlace of Service
The code that identifies where the service was performed. Options are:
| 01 | Pharmacy |
| 02 | Unassigned |
| 03 | School |
| 04 | Homeless Shelter |
| 05 | Indian Health Service Free-Standing Facility |
| 06 | Indian Health Service Provider-Based Facility |
| 07 | Tribal 638 Free-Standing Facility |
| 08 | Tribal 638 Provider-Based Facility |
| 09 | Prison/Correctional Facility |
| 10 | Unassigned |
| 11 | Office Location |
| 12 | Home |
| 13 | Assisted Living Facility |
| 14 | Group Home |
| 15 | Mobile Unit |
| 16 | Temporary Lodging |
| 17 | Walk-In Retail Health Clinic |
| 18 | Place of Employment/Worksite |
| 19 | Off Campus Outpatient Hospital |
| 20 | Urgent Care |
| 21 | Inpatient Hospital |
| 22 | On-Campus Outpatient Hospital |
| 23 | Emergency Room Hospital |
| 24 | Ambulatory Surgical Center |
| 25 | Birthing Center |
| 26 | Military Treatment Facility |
| 31 | Skilled Nursing Facility |
| 32 | Nursing Facility |
| 33 | Custodial Care Facility |
| 34 | Hospice |
| 41 | Ambulance - Land |
| 42 | Ambulance - Air or Water |
| 49 | Independent Clinic |
| 50 | Federally Qualified Health Center |
| 51 | Inpatient Psychiatric Facility |
| 52 | Psychiatric Facility - Partial Hospitalization |
| 53 | Community Mental Health Center |
| 54 | Intermediate Care Facility/Individual with Intellectual Disabilities |
| 55 | Residential Substance Abuse Treatment Facility |
| 56 | Psychiatric Residential Treatment Center |
| 57 | Non-Residential Substance Abuse Treatment Facility |
| 60 | Mass Immunization Center |
| 61 | Comprehensive Inpatient Rehabilitation Facility |
| 62 | Comprehensive Outpatient Rehabilitation Facility |
| 65 | End-Stage Renal Disease Treatment Facility |
| 71 | Public Health Clinic |
| 72 | Rural Health Clinic |
| 81 | Independent Laboratory |
| 82-98 | Unassigned |
| 99 | Other Place of Service |
Product/Service (Procedure) Code Qualifier. Options are:
| ER | Jurisdiction Specific Procedure and Supply Codes |
| HC | Health Care Financing Administration Common Procedural Coding System (HCPCS) Code |
| IV | Home Infusion EDI Coalition (HIEC) Product/Svc Code |
| WK | Advanced Billing Concepts (ABC) Codes |
Identifying number for a product or service.
Identifies special circumstances related to the performance of the service, as defined by trading partners.
Dollar value of the charge for the product or service listed in this service line.
Code to specify the units in which the value in the Units field is being expressed. Options are:
| MJ | Minutes - required for anesthesia claims |
| UN | Unit |
| F2 | International Unit (dosage, drug only) |
Quantity of the product or service listed in this service line.
The pointer numeral identifies which of the diagnoses on the claim links to this service line procedure. Up to four (4) diagnosis may be linked to each line in order of declining level of importance.
NOC Code DescriptionNOC Code Description
Not Otherwise Classified procedure code description.
Emergency IndicatorEmergency Indicator
Required when the service is known to be an emergency. (The patient requires immediate medical intervention.)
EPSDT IndicatorEPSDT Indicator
Required by Medicaid when services are the result of a screening referral.
Family Planning IndicatorFamily Planning Indicator
Required when applicable for Medicaid claims. Indicates Family Planning services were involved.
If code 0 is entered here, this indicates that the patient is exempt from a co-pay.
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