*** Effective Date: 2/22/2022
*** Master ***
"2000","Custom Invoice (Baseline) 02/22/22","Patient     ","N"
*** Option ***
"1","0","2000","LOC_1","10","7","Y","250",""," ","Remit-To Name/Address","","Y",""
"1","1","2000","LOC_1A","0","1"," ","0",""," ","Remit-To Layout",""," ",""
"1","2","2000","LOC_1B","0","2"," ","20",""," ","Bill Header Line",""," ",""
"2","0","2000","LOC_2","55","1","Y","0","","N","Patient's Name/Address","","Y",""
"3","0","2000","LOC_3","0","1"," ","0","","N","Patient Account No","","F",""
"5","1","2000","LOC_5A","38","1"," ","0",""," ","Patient Phone",""," ",""
"7","0","2000","LOC_7","54","1"," ","0","","N","Bill-To/Guarantor Name/Address","","Y",""
"7","1","2000","LOC_7A","39","1","F","0",""," ","Bill-To/Guarantor Phone",""," ",""
"7","2","2000","LOC_7B","74","2","Y","40",""," ","Bill-To/Guarantor Box Caption",""," ",""
"8","0","2000","LOC_8","20","1","Y","0",""," ","Billing Period","","Y",""
"11","0","2000","LOC_11","44","1"," ","0","","N","Insured's Group/Claim",""," ",""
"11","1","2000","LOC_11A","0","1"," ","0",""," ","Insured's Policy/Contract",""," ",""
"17","0","2000","LOC_17","105","1"," ","0","","N","Name of Referring Physician","","Y",""
"17","1","2000","LOC_17a","103","1"," ","0","","N","ID No of Referring Physician",""," ",""
"21","0","2000","LOC_21","28","1"," ","0","","N","Primary Diagnosis Code","","F",""
"21","1","2000","LOC_21A","100","4"," ","0",""," ","Diagnosis Descriptions","","Y",""
"24","0","2000","LOC_24_ITEMIZATION","501","5"," ","0","  1X XV  2X RV  3X XV  4X XV  5X XV  6X XV  7X XV  8X XS  9X XV 10X XV 11X XV 12X XV 13X XV 14X XV 15X XV 16X XV 17  XN","N","Itemizations","Select Modalities and Visits or Charges","Y",""
"24","1","2000","LOC_24_SORTING","1005","1","Y","0","","Y","Charge Sorting Options","Select Sort Order"," ",""
"24","2","2000","LOC_24_ITEM_CONSOLIDATION","1011","1","Y","0","","Y","Itemized Consolidation","Select Consolidation Option"," ",""
"24","3","2000","LOC_24_CPT","1018","4","Y","0","","Y","CPT/HCPCS",""," ",""
"24","5","2000","LOC_24_DESC","1020","1","Y","0",""," ","Service Description/Start-Stop",""," ",""
"24","6","2000","LOC_24_EMP","1038","1"," ","0",""," ","Care Giver/Chg-Rev/Hcpc",""," ",""
"24","7","2000","LOC_24_PRICE","1028","1"," ","0",""," ","Charge Price",""," ",""
"24","8","2000","LOC_24_COPAY","0","1"," ","0",""," ","CoPay Amount",""," ",""
"24","10","2000","LOC_CHGAMT","1031","1","Y","0",""," ","Charge Amount",""," ",""
"24","11","2000","LOC_ZNET","0","1"," ","0",""," ","Zero Net Charges",""," ",""
"24","12","2000","LOC_24_LINES","1029","1","Y","0",""," ","Charge Print Lines",""," ",""
"24","14","2000","LOC_24_DATA","500","4"," ","0",""," ","Charges Data Retrieval","","Y",""
"25","0","2000","LOC_25","17","1"," ","0","","N","Provider ID (Provider Area)","","Y",""
"26","0","2000","LOC_26","0","1"," ","0",""," ","Invoice Number",""," ",""
"27","0","2000","LOC_27","122","1","Y","0",""," ","Invoice Date",""," ",""
"28","0","2000","LOC_28","0","2"," ","2",""," ","Please Pay By This Date","The # days entered will be added to the date and a message will print at invoice bottom."," ",""
"30","0","2000","LOC_30","0","1"," ","0",""," ","Tear Off Stub (Bottom Section)",""," ",""
"30","1","2000","LOC_30A","0","2"," ","250",""," ","Bottom Message",""," ",""
"31","0","2000","LOC_31","0","7"," ","250",""," ","Comments (Center Section)",""," ",""
"32","0","2000","LOC_32","0","1"," ","0",""," ","Authorization Number",""," ",""
"33","0","2000","LOC_33","0","1"," ","0",""," ","Case Manager",""," ",""
"99","0","2000","DATE_FORMAT","1","4","Y","0",""," ","Format - Dates",""," ",""
"100","0","2000","UNIT_FORMAT","2","4","Y","0","","N","Format - Units","Select Format For Units"," ",""
"101","0","2000","MONEY_FORMAT","5","4","Y","0","","N","Format - Money","Select Format for Dollar Values"," ",""
"150","0","2000","SEL_INS","0","1"," ","0",""," ","Selected Insurances","Selected Insurances Option"," ",""
*** Choice ***
"1","0","2000","11","1","Provider Information From Patient Unit"
"1","0","2000","10","2","Provider Information From Control File"
"1","0","2000","1","3","Constant Value (Entered)"
"1","1","2000","74","1","Show Provider Name in Bold Font"
"1","2","2000","74","1","Enter Bill Header (Default is "INVOICE")"
"2","0","2000","55","1","Patient Name And Address"
"3","0","2000","12","1","Patient Number"
"3","0","2000","13","2","Patient Medical Record Number"
"3","0","2000","26","3","Patient Soc-Sec-No"
"5","1","2000","38","1","Patient Phone Number"
"7","0","2000","117","1","Insurance Name and Address (Current Insurance)"
"7","0","2000","54","2","Guarantor Name And Address"
"7","0","2000","56","3","Institution Name and Address"
"7","1","2000","39","1","Phone Number"
"7","2","2000","74","1","[Bill To:] or [Guarantor:] (Default)"
"7","2","2000","1","2","Constant Value (Entered)"
"8","0","2000","20","1","Charge First and Last Visit Dates"
"8","0","2000","22","2","System Bill From And To Dates (Use w/Multi-Patient Option)"
"8","0","2000","21","3","Patient Admit/Discharge and Bill Dates"
"11","0","2000","29","1","Insurance Claim Number"
"11","0","2000","88","2","Insurance Contract "
"11","0","2000","44","3","Insurance Group Code"
"11","1","2000","44","1","Insurance Group Code"
"11","1","2000","88","2","Insurance Contract"
"11","1","2000","29","3","Insurance Claim Number"
"17","0","2000","105","1","Physician Name"
"17","1","2000","103","1","Physician Taxonomy"
"21","0","2000","28","1","Diagnosis (Primary)"
"21","1","2000","100","1","Patient ICD-9 Descriptions"
"24","1","2000","1004","1","Sort by Revenue Code"
"24","1","2000","1003","2","Sort by Modality Sequence"
"24","1","2000","1005","3","Sort by Date/Modality Sequence"
"24","2","2000","1057","1","Revenue Code Consolidation"
"24","2","2000","1013","2","Revenue Code/Date Consolidation"
"24","2","2000","1011","3","Print Each Charge"
"24","3","2000","1018","1","Revenue Code"
"24","3","2000","1026","2","CPT Code Number"
"24","5","2000","1037","1","Charge Start/Stop Times"
"24","5","2000","1020","2","Charge Description"
"24","5","2000","1027","3","Charge Description w/HCPC Code"
"24","5","2000","118","4","Constant (Patient Copay Amount)"
"24","5","2000","1067","5","Charge Description and Start/Stop Times"
"24","6","2000","1021","1","Charge Revenue Description"
"24","6","2000","1038","2","Charge Employee Full Name"
"24","6","2000","1051","3","Charge Employee First Name"
"24","6","2000","1027","4","Charge HCPC Code"
"24","6","2000","1019","5","Charge Code"
"24","6","2000","1052","6","Charge Employee Care Type and Name"
"24","7","2000","1028","1","Charge Unit Price"
"24","7","2000","1031","2","Charge Net Amount"
"24","7","2000","1030","3","Charge Gross Amount"
"24","7","2000","1062","4","Charge Rate Net Amount"
"24","8","2000","77","1","Insurance Co-Pay Amount (Current Insurance)"
"24","10","2000","1030","1","Charge Gross Amount (Selected Charges)"
"24","10","2000","1031","2","Charge Net Amount (Selected Charges)"
"24","11","2000","1031","1","Include Zero Net Amount Charges"
"24","12","2000","1029","1","Max Charges Lines Per Page"
"24","12","2000","1015","2","Print One Charge Line Per Page"
"25","0","2000","17","1","System Federal Tax ID"
"25","0","2000","19","2","Unit Master Federal Tax ID (as License ID)"
"26","0","2000","74","1","Bill Master ID as Invoice #"
"26","0","2000","23","2","Code # - Bill Date as Invoice #"
"27","0","2000","121","1","System Billing Date"
"27","0","2000","122","2","System Todays Date"
"28","0","2000","76","1","Message Based on Today's Date"
"28","0","2000","74","2","Message Based on Bill Date"
"28","0","2000","43","3","Constant Message: Please pay this amount. Thank you"
"30","0","2000","74","1","Show Tear Off Stub Info"
"30","1","2000","118","1","Constant (Return this portion with your payment.)"
"30","1","2000","1","2","Constant Value (Entered)"
"31","0","2000","1","1","Constant Value (Entered)"
"32","0","2000","93","1","Treatment Authorization (First Found For Modality)"
"32","0","2000","95","2","Treatment Authorization (First Found)"
"32","0","2000","92","3","Treatment Authorization w/Matching ID"
"33","0","2000","102","1","Patient Team Description"
"99","0","2000","1025","1","Format date as MM/DD/YY"
"99","0","2000","1024","2","Format date as MMDDYY"
"99","0","2000","1026","3","Format date as MM DD YY"
"100","0","2000","3","1","Format Units With Leading Zeros"
"100","0","2000","2","2","Format Units With Leading Spaces"
"101","0","2000","6","1","Format Dollar Values Without Decimal Point Or Space"
"101","0","2000","4","2"," Format Dollar Values with Decimal Space"
"101","0","2000","5","3","Format Dollar Values With Decimal Point"
"150","0","2000","74","1","Store and Auto Select Insurances"
