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@@ -626,6 +626,15 @@
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<option value="UNKNOWN">Unknown</option>
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</select>
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</div>
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+ <div class="form-group">
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+ <label for="" class="control-label">Manual Is Payer Member Identifier Valid</label>
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+ <select name="manualIsPayerMemberIdentifierValid" class="form-control input-sm">
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+ <option value="">--select--</option>
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+ <option value="YES">Yes</option>
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+ <option value="NO">No</option>
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+ <option value="UNKNOWN">Unknown</option>
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+ </select>
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+ </div>
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<div class="form-group">
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<label for="" class="control-label">Manual Determination Category Memo</label>
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<input type="text" name="manualDeterminationCategoryMemo" class="form-control input-sm"/>
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=