Web interChange verification / insurance information / transportation / waiver-related services / Healthcare providers / Web interChange / pregnancy-related services / to providers rendering services / insurance plan name / /
Organization
OF SERVICE / 24B PLACE OF SERVICE / National Uniform Claim Committee / United Nations / PLACE OF SERVICE / Indiana Health Coverage Programs / NDC Unit / Medicare / /
Person
Qualifier Code / / /
Position
PHYSICIAN / Governor / manager name / qualifier / case manager / referring physician / /