| Name | Description | Type | Additional information |
|---|---|---|---|
| recordId | string |
None. |
|
| requestDate | string |
None. |
|
| requestTime | string |
None. |
|
| requestType | string |
None. |
|
| requestMethod | string |
None. |
|
| memberId | string |
None. |
|
| memberName | string |
None. |
|
| memberAddr | string |
None. |
|
| memberCity | string |
None. |
|
| memberState | string |
None. |
|
| memberZip | string |
None. |
|
| memberDOB | string |
None. |
|
| requestProviderId | string |
None. |
|
| requestProviderNPI | string |
None. |
|
| requestProviderTaxid | string |
None. |
|
| serProviderId | string |
None. |
|
| serProviderNPI | string |
None. |
|
| serProviderTaxid | string |
None. |
|
| placeOfService | string |
None. |
|
| requestDateFrom | string |
None. |
|
| requestDateThru | string |
None. |
|
| requestProviderName | string |
None. |
|
| requestProviderAdd | string |
None. |
|
| requestProviderCity | string |
None. |
|
| requestProviderState | string |
None. |
|
| requestProviderZip | string |
None. |
|
| requestProviderPhone | string |
None. |
|
| requestProviderFax | string |
None. |
|
| serProviderName | string |
None. |
|
| serProviderAdd | string |
None. |
|
| serProviderCity | string |
None. |
|
| serProviderState | string |
None. |
|
| serProviderZip | string |
None. |
|
| serProviderPhone | string |
None. |
|
| serProviderFax | string |
None. |
|
| requestReason | string |
None. |
|
| workComp | string |
None. |
|
| mvaSub | string |
None. |
|
| injuryDate | string |
None. |
|
| otherInsCov | string |
None. |
|
| otherInsName | string |
None. |
|
| otherInsMemberName | string |
None. |
|
| otherInsMemberId | string |
None. |
|
| printFlag | string |
None. |
|
| planId | string |
None. |
|
| planName | string |
None. |
|
| planTermDate | string |
None. |
|
| requestName | string |
None. |
|
| requestPhone | string |
None. |
|
| requestFax | string |
None. |
|
| memberGroupId | string |
None. |
|
| outPatientFlag | string |
None. |
|
| inofficeFlag | string |
None. |
|
| dmeFlag | string |
None. |
|
| therapyFlag | string |
None. |
|
| routineFlag | string |
None. |
|
| urgentFlag | string |
None. |
|
| authProcedures | Collection of AuthProcedure |
None. |
|
| authDiags | Collection of AuthDiag |
None. |
|
| authAttach | Collection of AuthAttach |
None. |