Specific Claims 25 Percent of Standard Maximum

Policyholder ID

ID number for the policyholder.

Policy No

Policy number.

Policyholder

Policy holder name.

Effective

When the policy became effective.

TPA

Third party administrator on the policy.

Spec Ded

Policy specific deductible.

Max

Policy maximum benefit.

Claimant

Who made the claim.

Birth Date

Claimant date of birth.

Diag

IDC-9 or IDC-10 diagnosis code for the claim.

Diagnosis Desc

Description of the diagnosis.

First DOS

First date of service on the claim.

Last DOS

Last date of service on the claim.

Original EOR Date

Date or the original Explanation of Reimbursement on the claim.

Carrier

Policy carrier.

Whether or not the claim triggers a warning.

Last Rec Date

Last received date.

Paid Total

Total claim paid.

Pended Total

Total pended amount on the claim.

Total Paid Pended

Total amount pended paid.

Excess Amount

Excess amount on the claim.