Provider Payment Calculation

HHSC returns the following fields on the paid claim response. Refer to the Claims Billing (B1) Transaction for instructions and payer sheets.

Field Name	Field Number
Patient Pay Amount	505-F5
Ingredient Cost Paid	506-F6
Dispensing Fee Paid	507-F7
Incentive Amount Paid	521-FL
Professional Service Fee Paid	562-J1
Other Payer Amount Recognized	566-J5
Total Amount Paid	509-F9
Basis of Reimbursement Determination	522-FM