Statements

checkmarkStatement – Sample – Standard statement showing charges, payments, and aging. Will only print if the patient has a balance due. Shows all transactions from claims not check marked as ‘Paid’.

downloadStatement for BillFlash Export – Standard statement used with the BillFlash electronic statement service.  See our BillFlash web page for more information.

downloadStatement with only Patient Balances – Sample – Standard statement but will only show service lines that have the responsible party set to ‘3 – Patient’, the claim is not archived, and the claim’s ‘Paid’ check box is unchecked.

downloadStatement Summary – Sample – Single line statement showing the total charges, insurance payments and adjustments, insurance balance, patient payments, and patient balance.

downloadStatement w No Return Address – Sample – Standard statement with no return address.

downloadStatement w Balance Forward – Sample – Asks for a balance forward date and will total all the previous balances as a single line item.

downloadStatement w Balance Forward no Tax ID – Sample – Asks for a balance forward date and will total all the previous balances as a single line item.

downloadStatement with Payment Notes – Sample – Payment notes will print on the statement below the payment. MUST be running Advanced 7 Release 27 or higher.

downloadStatement with Return Slip no Diags no Tax ID no Phone Number – Sample – Statement report with a return slip. No diagnostic codes, no Tax ID, and no phone number.

downloadStatement with Return Slip and patient grouping. – Sample – Statement report with a return slip and patient grouping. (e.g. A-L)

downloadStatement for Payer Billing – Sample – Statement report with a return slip. Shows the Payer address on the left and the patient name on the right. Updated 3/20/2006 to allow a date range to be entered.

downloadStatement with Return Slip no Diags no Tax ID – Sample – Statement report with a return slip. No diagnostic codes are shown. The Tax ID is not shown.

download Statement with Return Slip no Diags no Tax ID using a Date Range – Sample – Statement with date range report with a return slip. No diagnostic codes are shown. The Tax ID is not shown.

download Statement for Self Pay Patients no Tax ID – Sample – Statement for Self Pay Patients without the Tax ID.

downloadStatement with Return Slip no Diags – Sample – Statement report with a return slip. No diagnostic codes are shown.  ‘Bill To’ field available (more info).

downloadMonthly Statements – Sample – Monthly statements will print even if the patient has a zero balance and no matter what the Balance – Responsible Party is set to. The statement will print data from all claims ‘not archived’ and ‘not paid’. The provider Tax ID is removed and the diagnostic codes are removed.

downloadStatement for All Unpaid Claims – Sample – Statement report showing all service line data from claims not marked as paid.

downloadStatement with Facility Return Address Sample – Statement report with Facility Return Address.

downloadStatement with Facility Return Address with Pmt Ref 1 and 2 Fields – Statement report with Facility Return Address including payment ref 1 and 2 fields.

downloadStatement with Return Slip – Sample – Statement report with a return slip to cut off and return with payment.  ‘Bill To’ field available (more info).

downloadStatement using Date Range – Sample – Statement report that allows the use of dates ranges.

downloadStatement w No Tax ID or Phone – Sample – Statement report without the providers tax ID and phone number listed. Updated to include the second address line for the return address.

downloadStatement with Payment Reference 1 and 2 Fields – Sample – Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window.

downloadStatement with Return Slip no Diags with Pmt Ref 1 and 2 Fields – Sample – Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes.

downloadStatement with Return Slip no Diags no Procedure with Pmt Ref 1 and 2 Fields – Sample – Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes and no procedure codes.

downloadStatement with Return Slip no Diags no Procedure with Pmt Ref 1 and 2 Fields no Tax ID– Sample – Statement that shows the reference 1 and reference 2 fields from the Payments/Adjustments window and contains a Payment Slip with no diagnostic codes and no procedure codes and no Tax ID.

downloadStatement for Self Pay Patients – Sample – Statement report without the insurance information. This statement ignores the responsible party setting and assumes all balances are the responsibility of the patient.

downloadStatement for Self Pay Patients with Ref Fields 1 and 2 – Sample – Statement for Self Pay Patients with payment reference fields 1 and 2.

downloadStatement w No Tax ID – Sample – Statement report without the providers tax ID listed. Updated to use the reason code description for contract adjustments. Updated to include the second address line for the return address.

downloadStatement no Diags – Sample – Statement report without the diagnostic codes.