No changes can be made from this panel.

• Line Number
• Billable: Green checkmark = Yes; Red X = No
• DOS From & To
• Facility
• Rendering
• POS: Place of Service
• CPT® Code
• Description: Procedure Description
• Modifiers: M1, M2, M3, M4
• Dx Codes: Diagnoses that are linked to the specific line item
• Units
• RVUs (if applicable)
• Allowed Fee: From your Allowed Fee Schedule(s).
• Charge: Fee Amount

Partially Submitted Claims

Partially submitted and excluded lines are color-coded with hover-over information.

1. Included: Green check mark 
2. Excluded from the Claim: Red X

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