Credentials (required)
Username
Password
API Key
Processing:
Response:
Auto Notify:
Claim Transaction (required)
Claim Use Example "Naproxen" Claim String
Physician Info (optional)
Physician First Name
Physician Specialty
Physician NPI
Physician DEA
Physician Street Address
Physician City
Physician State
Physician Zip Code
Physician Phone #
Physician Fax #
Physician Email
Prescription Info (optional)
Prescription Sig
Rejection Code
Rejection Message
Help Phone
Preferred Product ID Qualifier
Preferred Product ID
Preferred Product Description
Original BIN/PCN/Group ID (optional)
BIN Number
PCN Number
Group ID
Transaction ID (optional - RelayHealth only)
Transaction ID