Provider billing data

NOTE: There are two file layout options presented below. One provides one row per unique combination of Dimension elements (Entity, Dept, CPTCode, Provider, FinClass, Location) with multiple value columns (RVU, WRVU, Gross Charges, etc.) The other provides a row per unique combination of Dimension elements and DataType (separate row for Gross Charges vs. WRVUs, etc.). Please select which one best fits the extract capabilities of the billing system your organization uses.

File layout

  • Recommend the file name begin with “PB_”
    • Example: PB_MMMYYYY

  • Each month should have a file, and each file should have a unique file name.

Field Description Opt/Req Field Type Length
Entity Entity or Hospital Identification Code R Numeric 5
GL Dept Department or Cost Center Number R Numeric 10
CPT Code CPT Summary Code or CPT Code Without Modifier1 R Text 25
Provider Provider Number R Text 50
FinClass Summary Financial Class2 R Text 50
Location Location of Encounter O Text 25
Current Month CPT Volume Volume for Current Month R Decimal 11.2
Current Month WRVU Worked RVU (Relative Value Unit) for Current Month R Decimal 11.2
Current Month RVU Gross Revenue for Current Month R Decimal 11.2
Month Revenue Total RVU (Relative Value Unit) for Current Month O Decimal 11.2
Current Month Visits (or Encounters) Visits/Encounters for Current Month R Decimal 11.2
Current Month Payment Payment for Current Month O Decimal 11.2
Current Month Allowance Allowance for Current Month O Decimal 11.2
  • Financial Class – Examples: Medicare, Medicaid, FFS, and Cap (Capitation). Examples include Medicare, Medicaid, BCBS, etc.
  • Data Type - Valid codes for Data Type are Encounter, Visit, Volume, WRVU, RVU and Revenue.
  • Visits or Encounters
    • If this data is not available from your billing system, the visit count can be summarized during the import process by flagging the Visit CPT codes in the CPT dimension, Type column.

    • Alternatively, you can provide visits in a separate file using the file layout below.

  • You may also provide data for Payments or Allowances. This data may be needed to calculate Percent of Net and Percent of Cash Collections Provider Compensation in the budget workbooks.