- Open the Visit Information screen
- In Box 19 place CT in the beginning and the clinical trial number (this must be 8 digits long) and no spaces.
- The electronic claim will create the data within the claim level information using the P4 qualifier required by Medicare.
Loop 2300 Claim Information
22 DTP*435*D8*20170810
23 REF*D9*270947853C19225D1
24 REF*EA*150443
25 REF*P4*11101280
26 NTE*ADD*CT11101280
27 HI*ABK:M19011*ABF:Z006