Additional Information Supporting Documentation-Charge Level *

Add Supporting Documentation to charge, if applicable

Additional charge information Supporting Documentation

Form Code-

Form Type Code-Required when adjudication is known to be impacted by one of the types

of supporting documentation (standardized paper forms) listed in LQ01.

1. Double Click on a charge line item to open Charge Details.

2. Click on tabs to add required information. These tabs will add information to each individual charge.

3. Select from drop down listing.

4. Click Save.

For information that will apply to all charges within the claim, see More Info.