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Each Statement Form contains the same basic information, such as Statement Page Count, Office Address, Statement Account Address, Account Number, Statement Message, and Statement Date. Each statement will also have columns for Procedure Date, Description, Charges, and Payments/Credits. You can read more about these in our Statement Form Fields / Anatomy of a Statement article.
There are a few key differences among the Statement Forms:
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The Statement 2 Column form includes a Charges column and a Payments column along with a Patient total and an Insurance total.
Statement 2 Column is a Finance Charge Information form.
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Statement 2 Column/Installment Amount
The Statement 2 Column/Installment Amount form includes the same information as the Statement the Statement 2 Column formColumn form, but uses a Minimum Amount Due Total in addition to the Patient Portion total and Insurance Portion total.
Statement 2 Column/Installment Amount is a Finance Charge Information form.
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In addition to the information listed on the Statement the Statement 2 Column, Statement 4 Column includes Insurance and Patient Column includes Insurance and Patient Portion columns. The resulting column order is Insurance Portion, Patient Portion, Charges, and Payments.
Statement 4 Column is a Finance Charge Information form.
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The Statement 4 Column/Installment Amount form includes the same information as the Statement the Statement 4 Column formColumn form, but uses a Minimum Amount Due Total in addition to the Patient Portion Total and Insurance Portion Total.
Statement 4 Column/Installment Amount is a Finance Charge Information form.
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Statement 5 Column
In addition to the information listed on the Statement 4 Column, Statement 5 Column includes a Balance column to add a running total for each statement item. The column order has also been formatted to put the Payments column next to the Balance column. The resulting column order is Charges, Insurance Pending, Patient Portion, and Payments/Credits, and Balance.
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The Statement 5 Column CC form includes the same information as the Statement 5 Column, but replaces the Finance Charge information with Credit Card information.
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The Statement 5 Column/Installment Amount form includes the same information as the Statement the Statement 5 Column formColumn form, but uses a Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.
Statement 5 Column/Installment Amount is a Finance Charge Information form.
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Statement 5 Column CC/Installment Amount
The Statement 5 Column CC/Installment Amount form is a combination of the Statement the Statement 5 Column CC and CC and Statement 5 Column/Installment Amount forms, including both the Credit Card Information and the Minimum Amount Due total in addition to the Patient Portion Total and Insurance Pending Total.
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The Statement CC (Credit Card) form presents a visual and format departure from the previous forms, but offers essentially the same information with the addition of Credit Card Information. The resulting order of the columns is Patient Name, Provider, Charges, Credits, and Balance.
Statement CC is a Credit Card Information form.
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The Statement Code and Diagnosis form includes columns for for Code and Diagnosis. Additional columns include Patient Name, Provider, Charges, Credits, and Balance.
Statement Code and Diagnosis is a Finance Charge Information form.
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Statement Code and Diagnosis/Installment Amount is a Finance Charge Information form.
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Statement Expected Insurance
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Statement Expected Insurance is a Finance a Finance Charge Information form.
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Statement Expected Insurance/Installment Amount
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Statement Expected Insurance/Installment Amount is a Finance a Finance Charge Information form.
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Statement FC CC
The Statement FC CC (Finance Charge Credit Card) statement form includes the same information as the Statement CC form: Patient Name, Provider, Charges, Credits, and Balance Columns, with the addition of Finance Charge Information.
Statement FC CC is a Finance a Finance Charge Information form and a Credit Card Information form.
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The Statement FC CC/Installment Amount form includes the same information as the Statement FC CC form, but uses a Minimum Due total in addition to the Total Balance.
Statement FC CC is a Finance a Finance Charge Information form and a Credit Card Information form.
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Statement Pending Insurance is a Finance a Finance Charge Information form and a Credit Card Information form.
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Statement Pending Insurance/Installment Amount is a Finance Charge Information form and a Credit Card Information form.
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