Docs · File formats
Medical Bill Review CSV format
Header names are matched automatically, in any order and any case. Extra columns are ignored.
| Column | Required | Also accepted as | Example |
|---|---|---|---|
| Provider | Yes | provider, provider name, billing provider, facility, hospital, practice | St. Mary's Regional Medical Center |
| Account / claim number | account number, account, account #, claim number, claim #, claim | HB-20931 | |
| Date of service | Yes | date of service, service date, dos, date | 2026-08-03 |
| CPT/HCPCS or revenue code | cpt/hcpcs, cpt, cpt code, hcpcs, procedure code, code | 99285 | |
| Description | description, service, item, charge description, service description | Emergency dept visit, high complexity | |
| Units | units, qty, quantity, unit count, units of service | 1 | |
| Billed amount | Yes | billed amount, billed, charge, charges, amount billed, gross charge | 2850.00 |
| Allowed amount (EOB) | allowed amount, allowed, eob allowed, plan allowed | 912.00 | |
| Plan paid (EOB) | plan paid, insurance paid, paid by plan, insurer paid, plan payment | 729.60 | |
| Patient responsibility (EOB) | patient responsibility, patient resp, member responsibility, you owe, eob patient responsibility, your responsibility | 182.40 | |
| Amount the provider billed you (balance due) | amount billed to patient, billed to patient, patient balance, balance due, amount due, statement balance | 182.40 | |
| Amount you paid | patient paid, paid by patient, payments, amount you paid, you paid, payment | 0 | |
| Network status | network status, network, in network, in/out of network, provider network | In-network | |
| Emergency (Y/N) | emergency, emergency (y/n), er, emergency visit | Y | |
| Facility network status | facility network, facility network status, facility in network, hospital network | In-network | |
| Insurer / health plan | insurer, health plan, plan, insurance, payer, insurance company | Aetna | |
| Uninsured / self-pay (Y/N) | self pay, self-pay, uninsured, self pay (y/n) | N | |
| Good Faith Estimate given (Y/N) | gfe given, good faith estimate given, gfe, good faith estimate | N | |
| Good Faith Estimate total for this provider | gfe amount, good faith estimate amount, estimate, gfe total, estimated amount | 2500.00 | |
| Bill date | bill date, statement date, billing date, invoice date | 2026-08-25 | |
| Discharge date | discharge date, discharged, date of discharge | 2026-08-05 |