New payment notice
Tell NPHIES a payer has paid.
Leave without saving?
This payment notice has unsaved changes. If you leave, they are lost.
Some details are missing. Fix 2 fields before you send: Payment reconciliation and Amount.
Payment notice details
Pick a reconciliation from your list so the identifier matches.
Pick a reconciliation from your list so the identifier matches.
Pick the reconciliation this notice refers to.
Organizations
Taken from Organization settings.
Payment information
Enter an amount greater than zero.
The identifier is generated for you.