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Invoice Extracted Fields Mapping

Invoice Extracted Fields Mapping

Learn which invoice data is extracted into fields with Unstructured Document Processing from the Provider Portal, including invoice dates, reference numbers, line-item amounts, quantities, prices, adjustments, and required formats.

Supported Invoice Information

Providers compare extracted values with the uploaded invoice and complete or correct supported fields before submitting a claim.

Field DEscription Format
ReferenceNumber The claim's invoice/reference number Text, required
SubmittedDate Invoice date MM/DD/YYYY
ReceivedDate Date the invoice was received MM/DD/YYYY
DueDate Payment due date MM/DD/YYYY
PaymentRequestLines[].ServiceAmount Line item total Number, required per line
PaymentRequestLines[].RequestedAmount Amount requested for that line Number
PaymentRequestLines[].AdjustmentAmount Discount, copay, or deductible adjustment Number
PaymentRequestLines[].Quantity Quantity of service on that line Whole number
PaymentRequestLines[].UnitPrice Price per unit on that line Number
PaymentRequestLines[].StartDateTime Service start date/time for that line MM/DD/YYYY HH:MM:SS
PaymentRequestLines[].EndDateTime Service end date/time for that line MM/DD/YYYY HH:MM:SS
 
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