Edit PDF Form
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SQL Query (.sql files added to queries folder will appear on this list) |
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select * from foersom
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Fields
| PDF Form Field Name | SQL Field Name |
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| ProviderContactTitle | |
| ProviderNPI | |
| ProviderName | |
| ProviderTaxIDEmployerID | |
| ProviderMedicaidID | |
| TradingPartnerID | |
| ProviderContactEmail | |
| ProviderContactFaxNumber | |
| ProviderContactName | |
| ClearinghouseContactName | |
| ClearinghouseEmail | |
| grpEnrollment | |
| SubmissionDate | |
| EffectiveERADate | |
| Title | |
| ClearinghousePhoneNumber | |
| ElectronicSignature | |
| ProviderContactExtension | |
| ProviderContactPhoneNumber | |
| ClearinghouseName | |
| Submit the Electronic Remittance Advice form to the KY Helpdesk at KY_EDI_Helpde More ... | |