| Prompt | Response | Req | Len |
|---|---|---|---|
| Doctor Code | Type the code you want or select from the Doctor list. | ![]() |
10 |
| Insurance Carrier | Type the code you want or click the magnifying glass to search the table. | ![]() |
5 |
| Provider Number | Type the provider number for this doctor and insurance carrier. | ![]() |
20 |