Claims Detail Screen
Locate the terms found in the claims detail screen.
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BRAND-NAME
DATE-OF-SERVICE
DATE-SUBMITTED
DAW-CODE
DAY-SUPPLY
DEA-CLASS
GENERIC-INDICATOR
GENERIC-NAME
GPI
MANUFACTURER
NABP
NDC
NPI
PRESCRIBER-ID
PRESCRIBER-NAME
PROVIDER-NAME
QUANTITY-DIPENSED
REJECTION-CODE
REJECTION-MESSAGE
REMAININGTROOP
RX-NUMBER
| X | M | D | A | T | E | - | S | U | B | M | I | T | T | E | D | V | V | L | T |
| X | T | I | V | B | Q | P | R | O | V | I | D | E | R | - | N | A | M | E | P |
| E | W | J | V | Y | Q | O | Q | C | Q | Q | I | H | E | T | J | J | U | R | R |
| M | P | R | K | D | F | O | E | H | T | H | K | H | J | O | Q | O | O | E | E |
| A | D | E | A | A | S | R | X | - | N | U | M | B | E | R | U | T | G | J | S |
| N | E | R | A | Y | O | T | R | Y | Q | M | R | H | C | F | A | P | M | E | C |
| - | A | U | W | - | B | G | K | K | C | F | Y | B | T | C | N | K | Y | C | R |
| D | - | T | D | S | Q | N | Z | R | X | O | I | L | I | I | T | S | Y | T | I |
| N | C | C | D | U | Q | I | J | G | W | O | P | D | O | Q | I | A | E | I | B |
| A | L | A | U | P | Y | N | Y | C | R | X | N | P | N | S | T | J | N | O | E |
| R | A | F | R | P | Q | I | R | X | Q | I | W | F | - | O | Y | T | J | N | R |
| B | S | U | O | L | Z | A | L | D | - | D | T | X | C | V | - | O | A | - | - |
| K | S | N | O | Y | K | M | A | C | Y | O | K | K | O | Y | D | H | H | M | I |
| Y | H | A | X | Z | A | E | I | E | C | Z | J | B | D | V | I | T | V | E | D |
| A | E | M | A | N | - | R | E | B | I | R | C | S | E | R | P | W | I | S | Z |
| F | I | K | X | F | E | E | L | K | J | N | X | L | B | R | E | D | L | S | K |
| I | C | C | D | N | A | B | P | O | C | Z | Q | U | O | M | N | S | S | A | Z |
| B | P | T | E | N | A | E | E | D | O | C | - | W | A | D | S | Z | X | G | M |
| D | O | G | E | N | E | R | I | C | - | N | A | M | E | I | E | T | L | E | P |
| F | E | C | I | V | R | E | S | - | F | O | - | E | T | A | D | B | B | J | C |
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