Patient Insurance Info
The following are the datasources for the report:
- Patient Name
- Coverage Level
- Status
- Effective From
- Effective To
- Payer Name
- Group Number
- Insured ID (Policy #)
- Copay Amount
- Copay Percent
- Notes
- Insured Name
- Insured Relation
- Insured Sex
- Insured Martial Status
- Insured Birth Date
- Insured SSN
- Insured Employment Status
- Insured Employer Name
- Insured Home Phone
- Insured Cell Phone
- Insured Biz Phone
- Insured Fax
- Insured Email
- Insured Address
- Insured City
- Insured State
- Insured Country
- Insure Zip
- Payer Financial Type
- Payer Fee Schedule
- Payer Contact Name
- Payer ID
- Payer Business Phone
- Payer Fax Number
- Payer Claims Phone
- Payer Claims Fax Number
- Payer Benefits Phone
- Payer Authorization Phone
- Payer Authorization Fax Number
- Payer Web Site
- Payer Email
- Payer Address
- Payer City
- Payer State
- Payer Country
- Payer Zip/Postal Code
- Payer Full Address
- Account #
- Account Status
- Address
- Birth Date
- Business Phone
- Cell Phone
- City
- Claim Contact Name
- Claim Contact Phone
- Contact Method
- Country
- Emergency Contact Name
- Emergency Contact Phone
- Emergency Contact Relation
- Employer
- Employment Status
- Ethnicity
- Financial Type
- Full Address
- Guarantor Address
- Guarantor Birth Date
- Guarantor Business Phone
- Guarantor City
- Guarantor Country
- Guarantor Full Address
- Guarantor Contact Phone
- Guarantor Name
- Guarantor Relation
- Guarantor Sex
- Guarantor State
- Guarantor Zip/Postal Code
- Home Phone
- Issuer
- Language
- Marital Status
- Patient Allergies
- Patient Notes
- Primary Insurance Payer
- Race
- Sex
- SSN
- State
- Zip/Postal Code