| Name | Description | Type | Additional information |
|---|---|---|---|
| PolicyNumber | string |
None. |
|
| ClaimNumber | string |
None. |
|
| TPAMemberID | string |
None. |
|
| DateandTimeofAdmission | string |
None. |
|
| DiseaseDescription | string |
None. |
|
| ClaimedAmount | string |
None. |
|
| EmployeeNumber | string |
None. |
|
| DateandTimeofintimation | string |
None. |
|
| InsuredName | string |
None. |
|
| PatientAddress | string |
None. |
|
| PatientCity | string |
None. |
|
| PatientState | string |
None. |
|
| ProviderName | string |
None. |
|
| ProviderCity | string |
None. |
|
| InitmatorMobileNumber | string |
None. |
|
| PayeeMailID | string |
None. |
|
| ClaimType | string |
None. |
|
| TPAName | string |
None. |
|
| ITGIMemberID | string |
None. |
|
| GroupName | string |
None. |
|
| NIDB | string |
None. |