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Superbill Variables

Use the respective Field ID in your XML file for the (field) information you want to appear on the final Superbill. Field IDs must appear in the XML exactly as they appear in the following tables in order for the desired information to be populated correctly.

Appointment Information

Field Description

Field ID

Appointment Alert on the Patient

@APPTALERT

Appointment Chief Complaint

@APPTCC

Appointment Comments

@APPTCOM

Appointment Date

@APPTDATE

Appointment Facility

@APPTFAC

Appointment Notes – Last Note Added to Appointment

@APPTNOTE

Appointment Provider

@APPTPRV

Appointment Resource

@APPTRES

Appointment Time

@APPTTIME

Appointment Type

@APPTTYPE

Next Appointment Date

@NEXTAPPTDT

Next Appointment Time

@NXTAPPT-TIME

Patient Last Seen

@PSEEN

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Facility Information

Field Description

Field ID

Address Line 1

@FACADDR

Address Line 2

@FACADDR2

@TFACADDR2

City

@FACCITY

State

@FACSTATE

Zip

@FACZIP

Phone

@FACPH

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Insurance Information

Default Primary Policy

Field Description

Field ID

Primary Payer Name

@INS1

Primary Policy Group #

@INS1GRP

Primary Policy Member ID

@INS1MEM

Primary Payer Address 1

@INS1ADDR

Primary Payer Address 2

@INS1ADDR2

Primary Payer City

@INS1CITY

Primary Payer State

@INS1STATE

Primary Payer Zip

@INS1ZIP

Primary Payer Phone

@INS1PH

Primary Policy Copay

@PCOP

Primary Policy Co-Insurance

@PCOINS

Primary Patient Deductible

@PDEDUCT

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Default Secondary Policy

Field Description

Field ID

Secondary Payer Name

@INS2

Secondary Policy Group #

@INS2GRP

Secondary Policy Member ID

@INS2MEM

Secondary Payer Address 1

@INS2ADDR

Secondary Payer Address 2

@INS2ADDR2

Secondary Payer City

@INS2CITY

Secondary Payer State

@INS2STATE

Secondary Payer Zip

@INS2ZIP

Secondary Payer Phone

@INS2PH

Secondary Policy Copay

@SCOP

Secondary Policy Co-Insurance

@SCOINS

Secondary Patient Deductible

@SDEDUCT

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Default Tertiary Policy

Field Description

Field ID

Tertiary Payer Name

@INS3

Tertiary Policy Group #

@INS3GRP

Tertiary Policy Member ID

@INS3MEM

Tertiary Payer Address 1

@INS3ADDR

Tertiary Payer Address 2

@INS3ADDR2

Tertiary Payer City

@INS3CITY

Tertiary Payer State

@INS3STATE

Tertiary Payer Zip

@INS3ZIP

Tertiary Payer Phone

@INS3PH

Tertiary Policy Copay

@TCOP

Tertiary Policy Co-Insurance

@TCOINS

Tertiary Patient Deductible

@TDEDUCT

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Insured Information

Default Primary Insured

Field Description

Field ID

Primary Insured Last Name

@PILAST

Primary Insured First Name

@PIFIRST

Primary Insured Middle Name

@PIMI

Primary Insured Name (Last, First Middle)

@PINAME1

Primary Insured Name (First Middle Last)

@PINAME2

Primary Insured Address 1

@PIADDR1

Primary Insured Address 2

@PIADDR2

Primary Insured City

@PICITY

Primary Insured State

@PISTATE

Primary Insured Zip

@PIZIP

Primary Insured Home Phone

@PIHOME

Primary Insured Work Phone

@PIWORK

Primary Insured Cell Phone

@PICELL

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Default Secondary Insured

Field Description

Field ID

Secondary Insured Last Name

@SILAST

Secondary Insured First Name

@SIFIRST

Secondary Insured Middle Name

@SIMI

Secondary Insured Name (Last, First Middle)

@SINAME1

Secondary Insured Name (First Middle Last)

@SINAME2

Secondary Insured Address 1

@SIADDR1

Secondary Insured Address 2

@SIADDR2

Secondary Insured City

@SICITY

Secondary Insured State

@SISTATE

Secondary Insured Zip

@SIZIP

Secondary Insured Home Phone

@SIHOME

Secondary Insured Work Phone

@SIWORK

Secondary Insured Cell Phone

@SICELL

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Default Tertiary Insured

Field Description

Field ID

Tertiary Insured Last Name

@TILAST

Tertiary Insured First Name

@TIFIRST

Tertiary Insured Middle Name

@TIMI

Tertiary Insured Name (Last, First Middle)

@TINAME1

Tertiary Insured Name (First Middle Last)

@TINAME2

Tertiary Insured Address 1

@TIADDR1

Tertiary Insured Address 2

@TIADDR2

Tertiary Insured City

@TICITY

Tertiary Insured State

@TISTATE

Tertiary Insured Zip

@TIZIP

Tertiary Insured Home Phone

@TIHOME

Tertiary Insured Work Phone

@TIWORK

Tertiary Insured Cell Phone

@TICELL

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Patient Information

Field Description

Field ID

Account#

@PACCT

Address Line 1

@PADDR1

Address Line 2

@PADDR2

Age

@PAGE

Balance Due Insurance

@IBAL

Balance Due Patient

@PBAL

Cell Phone

@PCELL

City

@PCITY

Co-insurance

@PCOINS

Co-pay

@PCOP

Credits Due Insurance

@PCRI

Credits Due Patient

@PCRP

Date Of Birth

@PDOB

Default ICD Codes

%DEFAULTICD

Deductible

@PDEDUCT

Email

@PEMAIL

First Name

@PFIRST

Full Address (Address City State Zip)

@PADDRFULL

Full Name (First MI Last)

@PNAME2

Full Name (Last, First MI)

@PNAME1

Home Phone

@PHOME

Last Name

@PLAST

Last Seen Date

@PLASTSEEN

Middle Initial

@PMI

Patient Reference

@PREF

Sex

@PSEX

State

@PSTATE

Work Phone

@PWORK

Zip Code

@PZIP

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Payer Information

Field Description

Field ID

Primary Payer Group Number

@IN1GRP

Primary Payer Member Number

@IN1MEM

Primary Payer Name

@TIN1

Secondary Payer Group Number

@IN2GRP

Secondary Payer Member Number

@IN2MEM

Secondary Payer Name

@TIN2

Primary Payer Address 1

@AINADDR1

Primary Payer Address 2

@AINADDR2

Primary Payer City

@AIN1CITY

Primary Payer Phone

@AIN1PH

Primary Payer State

@AIN1STATE

Primary Payer Zip code

@AIN1ZIP

Secondary Payer Address 1

@AIN2ADDR1

Secondary Payer Address 2

@AIN2ADDR2

Secondary Payer City

@AIN2CITY

Secondary Payer Phone

@AIN2PH

Secondary Payer State

@AIN2STATE

Secondary Payer Zip code

@AIN2ZIP

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Payment Plan Information

Field Description

Field ID

Next Installment Due Date

@NEXTINSTALLDATE

Next Installment Due Amount

@NEXTINSTALLAMTDUE

Overdue Balance Amount

@OVERDUEBAL

Total Payment Plan Balance

@PAYPLANBAL

https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Practice Information

Field Description

Field ID

Address Line 1

@PRADDR1

Address Line 2

@PRADDR2

City

@PRCITY

Full Address (Address City State Zip)

@PRADDFULL

Name

@PRNAME

Phone

@PRPH

State

@PRST

Zip Code

@PRZIP

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Provider Information

Field Description

Field ID

Provider Name

@PRVNAME

Provider’s Tax ID

@PRTAX

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Referring Information

Field Description

Field ID

Name

@REF

Address Line 1

@REFADDR1

Address Line 2

@REFADDR2

City

@REFCITY

State

@REFSTATE

Zip

@REFZIP

NPI

@REFNPI

UPIN

@REFUPIN

Fax

@REFFAX

Phone

@REFPH

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables

Other Information

Field Description

Field ID

Today’s Charge Amount

@TODCHGS

Today’s Date

@TODAY

 https://sites.google.com/a/collaboratemd.com/training/library/forms-and-templates/superbill-variables