{xl t='Name'} | ||
{xl t='Attn'} | ||
{xl t='Address'} | ||
{xl t='Address'} | ||
{xl t='City, State Zip'} | , | |
{xl t='Phone'} | ||
{xl t='CMS ID'} | {php} if ($GLOBALS['support_encounter_claims']) { {/php} {xl t='For Encounter Claims'}: {php} } {/php} | |
{xl t='Payer Type'} | {html_options name="freeb_type" options=$insurancecompany->freeb_type_array selected=$insurancecompany->get_freeb_type()} | |
{xl t='Default X12 Partner'} | {html_options name="x12_default_partner_id" options=$x12_partners selected=$insurancecompany->get_x12_default_partner_id()} | |