General Edit

{** * Insurance company edit * * @package OpenEMR * @link https://www.open-emr.org * @author Brady Miller * @copyright Copyright (c) 2017 Brady Miller * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 *} {if $insurancecompany->get_inactive() eq 1} {xlt t='Reactivate'}

{/if} {if $insurancecompany->get_inactive() eq 0} {xlt t='Deactivate'}

{/if} {xlt t='Name'} ({xlt t='Required'})

{xlt t='Attn'}

{xlt t='Address'}

{xlt t='Address'}

{xlt t='City'}

{xlt t='State'}

{xlt t='Zip Code'}

{xlt t='Phone'}

{xlt t='Fax'}

{xlt t='Payer ID'}

{if $SUPPORT_ENCOUNTER_CLAIMS} {xlt t='Payer ID For Encounter Claims'}

{/if} {if $SUPPORT_ELIGIBILITY_REQUESTS} {xlt t='Payer Id For Eligibility'}

{/if} {xlt t='Payer Type'} {html_options options=$insurancecompany->ins_type_code_array selected=$insurancecompany->get_ins_type_code()}

{xlt t='Default X12 Partner'} {html_options options=$x12_partners selected=$insurancecompany->get_x12_default_partner_id()}

{xlt t='CQM Source of Payment'} {html_options options=$insurancecompany->cqm_sop_array selected=$insurancecompany->get_cqm_sop()}

{if $SUPPORT_ELIGIBILITY_REQUESTS} {xlt t='Default Eligibility X12 Partner'} {html_options options=$x12_partners selected=$insurancecompany->get_x12_default_eligibility_id()}

{/if} {xlt t='Save'}{xlt t='Cancel'}