"If Case, Referral Access Number has a value blank, then send 9F. For the ANSI 5010, hardcode G1."

"If Case, Referral Access Number has a value, send that value. FLMC: If the Referring Provider, Default PINs tab, Medicaid PIN contains MP in the first positions, send everything after the MP In the ANSI 5010, if Case/Miscellaneous tab, Prior Authorization Number is Populated, create this segment."

"Send LX"

"Patient List, Case IDE Number"

"Hardcode 1J"

"Pull from Case/EDI Tab, Care Plan Oversight Number."

"Send X4"

"If Case, CLIA Number is not blank, send the Case, CLIA Number. Or if Provider, Provider IDs grid, CLIA Number is not blank, send the Provider, CLIA Number. Or if Facility, Facility IDs grid, CLIA Number is not blank, send the Facility, CLIA Number."

"Send DQ"

"If the Referring Providers window, Referring Provider IDs tab grid entry, Entity Type is Person, send Last Name. If the Referring Providers window, Referring Provider IDs tab grid entry, Entity Type is Non-Person, send Last Name plus First Name. Referring Provider, Last Name (Supervising Provider or Primary Care Provider)"

"Pick Up Location Address 1 from Ambulance tab of patient case."

"Pick Up Location Address 2 from Ambulance tab of patient case."

"Pick up Location City from the Ambulance tab in Patient case."

"Pick up Location State from the Ambulance tab in patient case."

"Pick up Location Zip from the Ambulance tab in Patient case."

"Hardcode 45"

"Drop Off Location Drop off Location from the Ambulance tab in Patient case."

"Drop Off Location Address 1 from Ambulance tab of patient case."

"Hardcode X4"

"If the Providers window, Provider IDs tab, Provider IDs grid entry CLIA button is selected, then send the value in the CLIA field"

"Send F4 Exception: If the code is 99000 or 36415 and the pos is 11 or 12, do not treat the entry as a purchased service. This applies applied to the claim level and to the transaction level."

"Facility, ID"