Grounded Field Extraction
CMS-1500 Health Insurance Claim Form
insured_id_number
XW1234567
95%
p.1
patient_name
Thornton, Emily R.
95%
p.1
prior_authorization_number
PA-0098765
95%
p.1
total_charge.amount
170.00
96%
p.1
total_charge.iso_4217_currency_code
USD
95%
p.1
service_lines[0].date_of_service_from
10 26 07
95%
p.1
service_lines[0].procedure_code
99213
95%
p.1
service_lines[0].line_charges.amount
125.00
96%
p.1
service_lines[0].line_charges.iso_4217_currency_code
USD
95%
p.1
service_lines[0].rendering_provider_npi
1234567890
95%
p.1
service_lines[1].date_of_service_from
10 07
95%
p.1
service_lines[1].procedure_code
87880
95%
p.1
service_lines[1].line_charges.amount
45.00
96%
p.1
service_lines[1].line_charges.iso_4217_currency_code
USD
95%
p.1
service_lines[1].rendering_provider_npi
1234567890
95%
p.1