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Date of Service (DOS): The date the healthcare service was provided.
Place of Service (POS): Where the service took place (e.g., hospital outpatient, physician's office).
Patient Name & Insurance Information: Identifies the patient and their insurance details.
Healthcare Provider: The doctor or healthcare professional who provided the service.
Current Procedural Terminology (CPT) Code: A unique code identifying the specific service performed.
Diagnosis Code(s) (ICD-10): Codes indicating the patient's diagnosis or condition.
Modifier(s): Additional codes specifying how the service was performed (e.g., unusual complexity).
Units: The number of times the service was performed (relevant for some procedures).
Allowed Amount: The maximum amount the insurance company will reimburse for the service.
Patient Responsibility: The amount the patient is responsible for after insurance coverage.
Payment Received: Tracks any payments received from the patient or insurance company.