PBM™ - On-line applications for TPAs, MCOs, self-insured employers, compensation systems, case management, compensation management, Medicaid HMOs, etc... SIMPLE SOFTWARE THAT WORKS!

Sample Forms and Reports
Generated by PBM Advantage™

PBM Advantage™'s system for managing your practice produces a vast array of Reports to streamline your operation.

We have a few sample forms created by the PBM Advantage™ system available online for viewing. They are available in several formats for review:

Download - .zip file containing Microsoft Word documents
Sample_PBM_Documents_Word.zip - 7KB

Download - Adobe Acrobat documents
Sample_PBM_Documents.pdf - 103KB

Or the pages can be viewed and printed from your browser.
Sample Invoice | Sample Letter | Sample Final Notice

Apply for PBM Membership Today!

Complete List of Reports
Generated by PBM Advantage™

PATIENT REGISTRATION #1 SUBMENU #1 SCREEN ON DEMAND

DAILY CHARGES
DAILY PAYMENTS
DAILY ADJUSTMENTS
DAILY CHARGE/PAYMENT/ADJUSTMENT
VIEW DAILY CHARGE/PAYMENT/ADJUSTMENT REPORT
TODAYS NEW PATIENTS
ALL PATIENTS ALPHABETICALLY
PATIENT DATA SHEETS
WRITE OFF OLD CLAIM AND CREATE NEW CLAIM

LISTED ON THE CLAIM SET UP SCREEN

PRINT A PATIENT MEDICAL RECORD
PRINT A MEDICAL PROTOCOL LISTED ON THE CLAIM SUMMARY SCREEN
PRINT A TIME OF SERVICE STATEMENT
PRINT HOMEGOING INSTRUCTIONS
PRINT WORK RELATED INSTRUCTIONS

ON DEMAND #2 MENU SUBMENU #1

ON DEMAND STATEMENTS (ENCOUNTER, PATIENT, FAMILY, GROUP)
ON DEMAND INSURANCE CLAIM FORM REFILE PRIMARY INSURANCE OR SECONDARY ENTIRE CLAIM OR BY LINE ITEM REFILE BY INDIVIDUAL PATIENT CLAIM OR ENTIRE BILLING CLASS OR A CERTAIN DUN LEVEL IN A BILLING CLASS TO/FROM DATE, INSURANCE CARRIER, EMPLOYER, ATTENDING PHYSICIAN
PRINT HCFA WITH OVERIDES FOR BOXES 25,24,33

ON DEMAND #2 MENU SUBMENU #3 IN-PATIENT PROCESSING

PRINT IN-PATIENTS BY ANY OF THE FOLLOWING (NAME, HOSPITAL, ADMIT DATE, PHYSICIAN)

ON DEMAND #2 MENU SUBMENU #4 LETTERS AND LABELS

PRINT INDIVIDUAL PATIENT LETTERS
PRINT INSURANCE CARRIER LETTERS
PRINT EMPLOYER LETTERS
PRINT INSURANCE CARRIER ADDRESS LABELS
PRINT PHYSICIANS ADDRESS LABELS
PRINT EMPLOYER ADDRESS LABELS
PRINT PATIENT BIRTHDAY LABELS
SPECIAL SELECTION CRITERIA FOR LETTERS LABELS FOR PATIENTS OR RESPONSIBLE PARTY COMBINATIONS OF 19 DIFFERENT PARAMETERS

ON DEMAND #2 MENU SUBMENU #5 CAPITATIVE PROCESSING

PRINT FUND GROUPS PAYMENT POSTING ON ACCOUNT #3 SUBMENU #1
PRINT AN EDIT LIST OF PAYMENT BATCH
PRINT UNAPPLIED PAYMENT LISTING
PRINT A CREDIT BALANCE REPORT
PRINT AN EDIT LIST OF PATIENTS TO GET REFUND CHECKS
PRINT REFUND CHECKS
PRINT PAYMENT ANALYSIS BY CPT CODE BY INS COMPANY

COLLECTIONS #4 SUBMENU #1

PRINT BROKEN PROMISE TO PAY REPORT
COLLECTOR ACTIVITY REPORT
IN-HOUSE COLLECTIONS RECEIPTS REPORT
ALL OUTSIDE COLLECTION ACCOUNTS
COLLECTION AGENCY EFFICIENCY REPORT

PATIENT INQUIRY #5

PRINT A PATIENT'S INFORMATION AND CLAIMS
PRINT PATIENT COMPLAINTS

#6 APPOINTMENT SCHEDULING

PRINT DAILY APPOINTMENT SCHEDULE
PRINT MISSED APPOINTMENTS
PRINT SUPERBILLS FOR ANY DAY OF APPOINTMENTS
PRINT PROVIDER'S SCHEDULE

ON DEMAND REPORTS #7
PRACTICE MANAGEMENT REPORTING #1

CASH COLLECTED AT TIME OF SERVICE REPORT BY RECEPTIONIST
A/R AGING REPORT BY BILLING CLASS
A/R AGING REPORT BY INSURANCE CARRIER/PHYSICIAN/DATES
A/R AGING REPORT BY PATIENT BY CLAIM WITH BILLING DATE
INSURANCE CARRIER DELINQUENCY REPORT/PHYSICIAN/DATES
CLAIM LISTING BY BILLING CLASS BY VARIOUS PARAMETERS (SAME REPORT AS IN AUTOMATIC CYCLE BILL REPORTS)
CHARGE HISTORY BY PHYSICIAN/LOCATION/CHARGE CODE
CHARGE HISTORY BY LOCATION/CHARGE CODE
CHARGE HISTORY BY CHARGE CODE (ALL LOCATIONS)
CHARGE HISTORY BY LOCATION/BILLING CLASS
CHARGE HISTORY BY BILLING CLASS (ALL LOCATIONS)

Apply for PBM™ Membership Today!

PRACTICE MANAGEMENT REPORTING #2

PAYMENT HISTORY BY LOCATION/PAYMENT TYPE
PAYMENT HISTORY BY PAYMENT TYPE (ALL LOCATIONS)
PAYMENT HISTORY BY LOCATION/BILLING CLASS
PAYMENT HISTORY BY BILLING CLASS (ALL LOCATIONS)
PAYMENT HISTORY BY LOCATION/PHYSICIAN/PAYMENT
ADJUSTMENT HISTORY BY LOCATION/ADJUSTMENT CODE
ADJUSTMENT HISTORY BY ADJUSTMENT (ALL LOCATIONS)
ADMIT/DISCHARGE REPORT
PHYSICIAN REFERRAL REPORT
CUSTOMIZED PATIENT ANALYSIS REPORT BY PATIENT OR RESPONSIBLE PARTY BY COMBINATION OF 16 DIFFERENT PARAMETERS
PRINT ALL PATIENT CLAIMS REPORT COMPLETE DETAIL
CHARGE/PAYMENT/ADJUSTMENT SUMMARY BY PHYSICIAN

PRACTICE MANAGEMENT REPORTING #3

PRINT CLAIMS WITH NO CHARGES
PRINT RETURN TO WORK FOLLOW UP REPORT
PRINT REVENUE TRACKING BACK TO POINT OF ENTRY REPORT
EOB REPORTS FOR MSO PROCESSING
REFERRING IN PROVIDER REPORT
REVENUE BY EMPLOYER BY YEAR
COVERING PROVIDER REPORT
ELECTRONIC CLAIMS SENT REPORT

PRACTICE MANAGEMENT REPORTING #4

CHARGES BY PHYSICIAN BY SPECIFIC DATES
DX CODE FREQUENCY REPORT
CPT CODE FREQUENCY REPORT
PATIENT LIST BY SEX AND BIRTHDATE
PATIENT LIST BY INSURANCE COMPANY
CHARGES BY BILLING CLASS/PHYSICIAN/DATES
PAYMENT CODE LISTING
CHARGE/PAYMENT/ADJUSTMENT BY LOCATION/PHYSICIAN/DATES
LIST PATIENTS BY ZIP-DETAIL/SUMMARY
PATIENTS NOT SEEN SINCE & LABELS
CHARGES, PAYMENTS, ADJUSTMENTS BY PROV BY SELECTED DATE
CHARGES, PAYMENTS, ADJUSTMENTS BY DAY CLOSE DATE
CAPITATED FUND PAYMENT LISTING BY DATE
SELECTED PATIENT LABELS
CHARGES, PAYMENTS, ADJUSTMENTS BY PROV BY DATES, DETAIL

PRACTICE MANAGEMENT REPORTING #5

PRINT PAYMENTS FOR CHARGES BY DOS SUMMARY/DETAIL
PRINT CLAIMS BY BILLING CLASS BY DOS
PRINT SELECTED DETAIL LETTERS
PRINT CHARGE/PAYMENTS BY PROV BY BILLING CLASS BY DOS
PATIENTS BY PROV/DATES/CPT CODE/MODIFIER
C/P/A BY INS CO. OR INS GROUP BY DOS RANGE
PAYOR MIX BY PAYMENTS AND CHARGES
C/P/A BY INS CO. BY DAY CLOSE DATE RANGE
NUMBER OF VISITS BY DOS RANGE
PAYMENTS BY PAYMENT CODE
FEE FOR SERVICE VS CAPITATED CHARGES REPORT

PRACTICE MANAGEMENT REPORTING #6

DISPLAY DX BY PATIENT
MAINTAIN PATIENT FLAGS
INSURANCE FREQUENCY REPORTS
PAYMENTS FROM/TO PAYMENT DATE BY INS CO. & PAY CODE
NEW PATIENTS BY DATE AND LOCATION
PATIENT/ADDRESS LISTING
CREATE RESPONSIBLE PARTY ADDRESS/NAME FILE FOR IMPORT
LIST NEW PATIENTS FROM/TO DATE
PRODUCTIVITY REPORT BY DAY CLOSE DATE BY OPERATOR
STANDARD REIMBURSEMENT REPORT BY INS AND CHARGE CODE
LOOK UP OPERATOR'S INITIALS FOR DEMO AND CLAIM INFO INPUT
LOOK UP SCHEDULER'S INITIALS

SET UP SPECIAL DATA FIELDS #8 SUB MENU #1

PRINT CHARGE CODE TRACKING REPORT
PRINT CHARGE CODE TRACKING LETTERS AND LABELS
PRINT PATIENT'S MEDICAL RECORD INFORMATION
PRINT MEDICAL RECORD HEADINGS/TEXT
PRINT LIST OF MEDICAL RECORD EDITS

DAILY CLOSING #9 REPORTS SELECT BY PRACTICE

CHARGE REPORTS
PAYMENT REPORTS
ADJUSTMENT REPORTS
TODAYS UNAPPLIED PAYMENTS
UNAPPLIED PAYMENT TRANSFER REPORT
DAILY INSURANCE FORM LISTING
IN-HOUSE COLLECTION RECEIPTS REPORT
IN-PATIENT REPORT
PATIENT COMPLAINT REPORT
PHYSICIAN REFERRAL REPORT
ADMIT/DISCHARGE REPORT
MISC. INSURANCE/EMPLOYERS TO UPDATE MAINT. FILES
A/R BY BILLING CLASS
FILE MAINTENANCE AUDIT REPORT
MISSED APPOINTMENTS REPORT
TOMORROW'S APPOINTMENTS

MONTH END CLOSING REPORTS SELECT BY PRACTICE

CHARGE HISTORY BY PHYSICIAN/LOCATION/CHARGE CODE
CHARGE HISTORY BY LOCATION/CHARGE CODE
CHARGE HISTORY BY CHARGE CODE (ALL LOCATIONS)
CHARGE HISTORY BY LOCATION/BILLING CLASS
CHARGE HISTORY BY BILLING CLASS (ALL LOCATIONS)
CHARGE HISTORY BY PHYSICIAN/LOCATION

CAPITATIVE CHARGE REPORTS SAME AS ABOVE

PAYMENT HISTORY BY LOCATION/PAYMENT CODE
PAYMENT HISTORY BY PAYMENT CODE (ALL LOCATIONS)
PAYMENT HISTORY BY LOCATION/BILLING CLASS
PAYMENT HISTORY BY BILLING CLASS (ALL LOCATIONS)
PAYMENT HISTORY BY LOCATION/PHYSICIAN/PAY CODE
PAYMENT HISTORY BY PHYSICIAN/PAYMENT CODE
PAYMENT HISTORY BY PHYSICIAN/LOCATION

CAPITATIVE PAYMENT REPORTS BY FUND GROUPS CAPITATIVE PAYMENT PATIENT CO-PAYMENT AMOUNTS

ADJUSTMENT HISTORY BY LOCATION/ADJUSTMENT CODE
ADJUSTMENT HISTORY BY ADJUSTMENT CODE (ALL LOC)
ADJUSTMENT HISTORY BY PHYSICIAN/ADJUSTMENT CODE

CAPITATIVE ADJUSTMENT REPORTS

CLOSED PATIENT COMPLAINT REPORT
PHYSICIAN REFERRAL REPORT
ADMIT/DISCHARGE REPORT
A/R AGING BY BILLING CLASS
A/R AGING BY PATIENT
TIME OF SERVICE CASH REPORT
ALL UNAPPLIED PAYMENTS LISTING
CHARGE/PAYMENT/ADJUSTMENT SUMMARY HISTORY WITH THIS PERIODS UNAPPLIED PAYMENTS
PRINT REVENUE BY POINT OF ENTRY REPORT
COLLECTION PERCENTAGE REPORT
AVERAGE DAYS RECEIVABLE REPORT
COVERED PHYSICIAN REPORT

MAINTENANCE FILES #10 SUBMENU #1

PRINT GENERAL PRACTICE INFORMATION
PRINT PHYSICIAN SPECIALTY CODES
PRINT PHYSICIAN INFORMATION
ATTENDING/REFERRING IN AND OUT
PRINT LOCATION INFORMATION
PRINT ACCOUNTING PERIODS

SUBMENU #2

PRINT STATEMENT MESSAGE TEXT
PRINT LETTER TEXT
PRINT CYCLE BILLING REPORT TYPES
PRINT BILLING CLASS TABLES
PRINT BILLING CLASS GROUPS
PRINT FAMILY/PATIENT STATEMENT TABLES

SUBMENU #3

PRINT DIAGNOSIS GROUPING CODES
PRINT DIAGNOSIS CODES BY SIX DIFFERENT COMBINATIONS OF GROUP CODES/DESCRIPTION/ICD9 CODE/ALPHANUM CODE
PRINT HOMEGOING INSTRUCTIONS AND MEDICAL PROTOCOLS

SUBMENU #4

PRINT CHARGE GROUPING CODES
PRINT CHARGE CODES FOUR DIFFERENT WAYS OR JUST PRINT ONE SET OF CODES FOR A PARTICULAR GROUP
PRINT MANDATORY AND OPTIONAL CHARGE CODES

SUBMENU #5

PRINT ADJUSTMENT/PAYMENT CODES
PRINT COLLECTION AGENCY INFORMATION
PRINT COMMENT CODES
PRINT EMPLOYER INFORMATION
PRINT HOSPITAL INFORMATION
PRINT INSURANCE CARRIER INFORMATION
PRINT SYSTEM OPERATORS INFORMATION
PRINT ZIP CODES

Apply for PBM™ Membership Today!

MISCELLANEOUS REPORTS

PAYMENTS ON CLAIMS TURNED TO OUTSIDE COLLECTORS BY COLLECTOR AND BY TO/FROM DATES
A/R AGING BY INDIVIDUAL PATIENT CLAIM BY DOCTOR AND BY LOCATION
LISTING OF ALL CLAIMS SHOWING TOTAL CHARGES/ADJUSTMENTS/PAYMENTS/BALANCE
LISTING OF ALL PATIENTS SEEN BY PHYSICIAN SHOWING THE FIRST/SECOND/THIRD DIAGNOSIS (ICD9 & DESCRIPTION)
LISTING OF CLAIMS CHARGES/PAYMENTS/ADJUSTMENTS BY INSURANCE CARRIER WITH TOTALS
LISTING OF CHARGES, PAYMENTS OR ADJUSTMENTS BY DOCTOR AND LOCATION AND MONTH
LISTING OF CHARGES, PAYMENTS OR ADJUSTMENTS BY DOCTOR, LOCATION, INSURANCE CARRIER, BY TO/FROM DATES
LISTING OF TOTAL # CLAIMS ON SYSTEM BY YEAR
LISTING PATIENTS WITH TOTAL DUE BY PATIENT
DIAGNOSIS CODE FREQUENCY REPORT
PRINT PAYMENTS BY PATIENT BY MONTH
PRINT NUMBER OF TIMES A DIAGNOSIS CODE IS USED
PRINT CLAIMS WITH A SPECIAL CPT CODE
PRINT PATIENT CLAIM TOTALS BY PHYSICIAN
PRINT TOTAL OF PATIENT'S CHARGES, PAYMENTS AND ADJUSTMENTS BY PATIENT
PRINT TOTAL PATIENT ENCOUNTERS AND TALLY
CHARGES, PAYMENTS, ADJUSTMENTS FOR ALL OPEN CLAIMS FOR A PARTICULAR YEAR
CHARGES, PAYMENTS, ADJUSTMENTS FOR A PARTICULAR . INSURANCE CARRIER
MONTH END REPORTS RERUN FOR ANY PERIOD IN CURRENT YEAR

Apply for PBM™ Membership Today!

CYCLE BILLING USER SELECTABLE REPORTS

LISTING OF ENCOUNTER/PATIENT/FAMILY STATEMENTS PRINTED
LISTING OF PATIENT LETTERS PRINTED
LISTING OF PATIENT FINAL NOTICES PRINTED
LISTING OF ELECTRONIC CLAIM REFILES
LISTING OF AUTOMATIC INSURANCE CLAIM REFILES GENERATED
LISTING OF INSURANCE/EMPLOYER LETTERS PRINTED
LISTING OF EMPLOYER/GROUP STATEMENTS PRINTED
LISTING OF BILLING CHARGES GENERATED
LISTING OF AUTOMATIC WRITEOFF ADJUSTMENTS GENERATED

PATIENT & PHYSICIAN SCHEDULING ADVANCED

LIST OF PATIENT APPOINTMENTS BY DOCTOR/LOCATION/DATES
LIST OF MISSED APPOINTMENTS
LIST OF CANCELED APPOINTMENTS BY STATUS CODE
PHYSICIAN'S SCHEDULE BY LOCATION/DATES/TYPES OF BLOCKING CODE
LIST OF WAITING PATIENTS FOR NEXT AVAILABLE CANCELED APPOINTMENTS BY DOCTOR CAPITATED CARRIER REPORTS
PBM HAS A HOST OF REPORTS BOTH CHARGE CODE VS PAYMENT TRACKING AND CLINICAL TRACKING.

MSO REPORTING

EXPLANATION OF PAYMENT REPORT BY LOCATION/DOCTOR/INSURANCE CARRIER/BILLING CLASS CPT CODE AND PRIMARY DIAGNOSIS FROM/TO DATES

THIS REPORT SHOWS REVENUE BY PATIENT WITH CHARGES AND ADJUSTMENTS. IT SHOWS INCREMENTAL PAYMENTS FOR THE MONTH AND CALCULATES THE MSO FEE AND THE NET TO THE DOCTOR. THEN SHOWS TOTALS FOR EACH DOCTOR/LOCATION AND GIVES THE FEDERAL ID NUMBER FOR THE DOCTOR SO THE MSO CAN CUT A CHECK TO EACH DOCTOR OR PRACTICE.

THIS CAN BE RUN ON-DEMAND AND/OR INCLUDED IN THE MONTH END REPORTS.

PHYSICIAN REFERRAL REVENUE REPORT

IN-DEPTH REPORT BY PHYSICIAN BY LOCATION BY TO/FROM DATES WHICH LISTS THE ACTUAL REFERRALS BY THE REFERRING "IN" DOCTOR NAME, TOTALS THE NUMBERS BY DOCTOR AND GIVES PERCENTAGES OF REFERRALS TO EACH ATTENDING PHYSICIAN IN THE PRACTICE, THEN RECALCULATES PERCENTAGES FOR EACH ATTENDING AS A PART OF THE ENTIRE PRACTICE. PERCENTAGES ARE GIVEN FOR #'S OF REFERRALS, CHARGES, AND PAYMENTS TO EACH ATTENDING AND THEN THE PRACTICE

Apply for PBM™ Membership Today!

Other PBM Services