Export Claim Custom Field Information

1. Overview

Purpose:
This report shows the claims custom field information along with claim information during a selecteddate range

Target Audience:
Billers, Admin

2. Report Location

Navigation Path in System:
Reports >> Billing Reports >> Exports >> Export Claim Custom Field Information

3. Report Filters & Parameters

Filter Name	Description
Service Date	Restricts the results to a selected service date range
Transaction Date	Restricts the results to a selected transaction date range
Diags	Restricts the results to one or more Diagnosis Codes
Referring Physicians	Restricts the results to one or more Referring Physicians
Procedure Codes	Restricts the results to one or more Procedure Codes
Master Physician	Restricts the results to one or more Master Physicians
Primary Insurance Carriers	Restricts the results to one or more primary insurance carriers
Custom Fields	Restricts the results to one or more custom fields
Location	Restricts results to one or more locations
No Credited Services	Restricts results to not include credited services
Just Credits	Restricts results to credited services only
Both	Restricts results to both Credits and No credited services

4. Output Columns

Column Name	Description
LOCNAME	Name of the location
ACCTNO	Patient account number
LNAME	Patient last name
FNAME	Patient first name
MI	Patient middle initials
EMAIL	Patient email address
ADDRESS1	Patient address 1
ADDRESS2	Patient address 2
CITY	Patient city
STATE	Patient State
ZIP	Patient zip code
PHONE_RES	Patient residence phone number
PHONE_OFF	Patient office phone number
PHONE_EXTENSION	Patient office phone extension number
CELLPHONE	Patient cell phone number
FAXNUMBER	Patient fax number
SEX	Patient gender
DOB	Patient Date of birth
PATPHYS	Name of the physician
PATREFPHYS	Name of the referring physician
CLAIMID	Criterions claim id
DOS	Date of service
TRANSDATE	Transaction date
AGINGDATE	Claim aging date
CHARGE	Claim charge amount
UNITS	Number of units billed
BALANCE	Balance amount
ALLOWED	Claim allowed amount
WRITEOFF	Claim write off amount
RECEIVEDPRIMARY	Amount received from Primary insurance
RECEIVEDOTHER	Amount received from Other insurance
RECEIVEDTOTAL	Total Received amount
NONALLOWED	Claim non allowed amount
BATCHNO	Batch number
MOD1	Modifier1
MOD2	Modifier2
MOD3	Modifier3
MOD4	Modifier4
POS	Place of service
TOS	Type of service
CLAIMPHYS	Name of the Physician name on the claim
CLAIMREFPHYS	Name of the Referring Physician name on the claim
PROCEDUREGROUP	Procedure group
CODE	CPT code
DIAG1	Diagnosis 1
DIAG2	Diagnosis 2
DIAG3	Diagnosis 3
DIAG4	Diagnosis 4
DIAG5	Diagnosis 5
DIAG6	Diagnosis 6
DIAG7	Diagnosis 7
DIAG8	Diagnosis 8
DIAG9	Diagnosis 9
DIAG10	Diagnosis 10
DIAG11	Diagnosis 11
DIAG12	Diagnosis 12
PRIINSNAME	Primary insurance name
PRIINSQWIK	Primary insurance QWIK code
PRIPOLNO	Primary policy number
INSTYPENAME	Primary insurance type
DUEFROMINSNAME	Name of the Due From insurance
DUEFROMINSQWIK	QWIK code of the Due From insurance
DUEFROMPOLNO	Policy number of the Due From insurance
SECINSNAME	Secondary insurance name
SECINSQWIK	Secondary insurance Qwik code
SECPOLNO	Secondary insurance policy number
FACID	Facility ID
FACNAME	Facility Name
CUSTOMDESC	Description of the custom field added in claim information
CUSTOMVALUE	Value of the custom field added in claim information

5. Report Grouping / Sorting Behavior

Grouped by Location, sorted by Account number ascending

6. Export Options

Available for export in CSV format

7. Special Notes / Tips

• Includes claim information like patient demographics, billed charges, physician etc.

8. Sample Screenshot

9. Version History

Version	Date	Description
1.0	2025-08-04	Initial documentation created