Payer NameExtract the insurance company/payer name...
Payer IDExtract the payer ID number...
Patient NameExtract the patient name...
Patient IDExtract the patient/member ID number...
Provider NameExtract the provider/facility name...
Provider NPIExtract the provider NPI if shown...
Claim NumberExtract the claim number or DCN...
Date of ServiceExtract the date(s) of service. Return in YYYY-MM-...
Statement DateExtract the EOB statement date. Return in YYYY-MM-...
Billed AmountExtract the total billed/charged amount...
Allowed AmountExtract the allowed/approved amount...
Deductible AppliedExtract the deductible amount applied...
CoinsuranceExtract the coinsurance amount (patient responsibi...
CopayExtract the copay amount...
Paid AmountExtract the amount paid by insurance...
Patient ResponsibilityExtract the total patient responsibility amount...
Adjustment AmountExtract any adjustment/write-off amount...
Adjustment ReasonExtract the adjustment reason code and description...
Line ItemsExtract service line items as JSON array with keys...
Denial CodesList any denial or rejection reason codes (CARC/RA...
Denial ReasonsList denial reason descriptions in plain text...
Payment StatusIdentify overall status: Paid in Full, Partially P...
Check NumberExtract the payment check/EFT number if shown...
Check DateExtract the payment date. Return in YYYY-MM-DD for...
Appeal DeadlineExtract the appeal deadline if mentioned. Return i...