| Name | Description | Type | Additional information |
|---|---|---|---|
| FacilityId | integer |
Required |
|
| RegistrationNo | integer |
Required |
|
| PolicyNo | string |
None. |
|
| SponsorId | string |
Required |
|
| PayerId | string |
Required |
|
| RequestFileName | string |
Required |
|
| Remarks | string |
None. |
|
| source | string |
Required |
|
| CardID | integer |
Required |
|
| PolicyAmount | decimal number |
None. |
|
| EmployeeId | string |
Required |
|
| EncounterId | string |
None. |
|
| CardNumber | string |
Required |
|
| SubmissionType | string |
Required |
|
| SubmissionTypeId | integer |
Required |
|
| RN_Reference_number | string |
Required |