| Prompt |
Response |
Req |
Len |
| For Electronic Form |
Select the code you want from the Electronic
Form list. |
 |
2 |
| All or Select Carriers |
Select the option you want, to include
either All carriers or a Select carrier from within the Electronic
Form type. |
 |
1 |
| Carrier Code |
Type the code you want, click the magnifying
glass to search the table or leave the field blank to include
all codes in the table. |
|
5 |
| All or Select Doctors |
Select the option you want to include
claims for All Doctors or a Select Doctor. |
 |
1 |
| Doctor Code |
Type the code you want, select a code
from the Doctor Code list, or leave the field blank to include
all codes in the table. |
|
5 |