Broccoli Scenario Details

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Invoice for treatment for client from Banana claim scenario

Patient:                                                               Barry Banana
DOB:                                                                    (03/06/1950)

Claim:                                                                  QQ00018
Accident Date:                                                    20/11/2017

Invoice Line Details
Service Code:                                                    GP1 (Or whichever service code your provider type uses)
Contract ID:                                                       80 (or whichever contract ID your provider type uses)
Service Date:                                                     Today's date
Billing Method:                                                  Units
Units Claimed:                                                   Empty
Invoice Amount:                                                31.53 (or the amount for the service you have chosen)
Invoice Comment:                                            Test invoice for Broccoli scenario
Purchase Order number:                                0000111

Provider:                                                            Your Test Provider ID
Vendor:                                                              Your Test Vendor ID
Declaration Date:                                             Today's date