MOC - ProviderDetails

Any fields not required for the particular claim being lodged will be greyed out.
MOC - ProviderDetails
1

Provider - Servicing

1. Provider - Servicing
Servicing Provider is the provider number of the medical practitioner rendering the service(s) as allocated by Medicare
 
2

Provider - Payee

2. Provider - Payee
 
Payee Provider Number is the provider number of the principal provider where the payment is to be directed to other than the servicing provider.
  • BulkBill - Must not equal provider servicing.
  • DVA, VAA - Required