Prime Clinical
Systems, Inc.
3675
E. Huntington Drive, Suite A
Pasadena,
CA 91107
May 14,
2015
Dear
Client,
Attached are
blank
Superbill Templates, in a Microsoft
Word format, which can be copied.
Because
of programming requirements, the
top portion of the Superbill (the
top portion is the patient information
that pulls from the Intellect
program), cannot be modified,
and the spacing must remain as
is in the template provided.
The CPT codes
and Diagnosis codes need to be
entered by you, or your designated
staff, in the blank boxes of the
template. Your office may need
an additional
page for the diagnosis
codes (see attached).
All the
information in the top portion
is pre-programmed to print from
your Intellect program. If you
wish to opt out of some of the
fields, the fields will remain
and no data will print in that
portion of the Superbill.
*** This information
is only for clients printing Superbills
from Intellect ***
Super Bill
Restrictions:
1.
Superbill must be in Microsoft
Word format.
2.
Up to 200 spaces are allowed for
procedure & diagnoses codes,
including the Patient Demographics.
For additional Diagnoses, an additional
page
may be added which will print
on a second page or, if using
a printer that has duplex printing
capability, the additional page
may be printed on the back side
of the first page.
3.
Margins must be ¼" on top,
bottom, and sides. The spacing
in the top portion, the area that
pulls from Intellect, must also
remain the same.
4.
Due to the size limitations of
the Superbill, only the Company
Name may be included at the top
of the Superbill.
•
No changes may be made to the
top portion of the template (area
that pulls from Intellect).
•
Fee for loading and programming
is approximately $150.00 per form
(including additional diagnosis
page, if used).
Sincerely,
Prime Clinical
Systems, Inc.
Support
and Training |
