361 lines
16 KiB
XML
361 lines
16 KiB
XML
<?xml version="1.0" encoding="UTF-8"?>
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<!-- Created with Jaspersoft Studio version 7.0.3.final using JasperReports Library version 6.1.1 -->
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<property name="ireport.zoom" value="2.0"/>
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<property name="ireport.x" value="32"/>
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<subDataset name="LogoDataset" uuid="5f867a6e-5835-4d64-a042-be4308e843e6">
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<parameter name="LOGO_FILENAME" class="java.lang.String"/>
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<field name="filename" class="java.lang.String"/>
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<field name="image_stream" class="java.io.InputStream"/>
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<field name="aspect_ratio" class="java.lang.Float"/>
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<filterExpression><![CDATA[$F{filename}.equals($P{LOGO_FILENAME})]]></filterExpression>
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</subDataset>
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<parameter name="networkLogosList" class="java.util.List" isForPrompting="false"/>
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<field name="network_logo_filename" class="java.lang.String"/>
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<field name="provider_line_1" class="java.lang.String"/>
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<field name="provider_line_3" class="java.lang.String"/>
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<field name="provider_line_2" class="java.lang.String"/>
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<field name="provider_line_4" class="java.lang.String"/>
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<field name="provider_line_5" class="java.lang.String"/>
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<field name="provider_line_8" class="java.lang.String"/>
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<field name="provider_line_9" class="java.lang.String"/>
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<field name="provider_line_10" class="java.lang.String"/>
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<field name="claim_to_11" class="java.lang.String"/>
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<textElement>
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<font size="6" isBold="true" isUnderline="false"/>
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<text><![CDATA[Eligibility]]></text>
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
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<text><![CDATA[Utilization / Pre-Cert]]></text>
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<textElement>
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<font size="6" isBold="true" isUnderline="false" isPdfEmbedded="false"/>
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<text><![CDATA[Claims Submission]]></text>
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[To confirm eligibility, verify benefits,
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or check claim:
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]]></text>
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[Britton Benefit Services, LLC]]></text>
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<font size="6" isBold="true" isItalic="false"/>
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</textElement>
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<text><![CDATA[Call:
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1.800.676.1182 (8am – 5pm)
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Online:
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www.bbstpa.com (24/7)
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This card does not guarantee
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eligibility or payment
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]]></text>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_1}]]></textFieldExpression>
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<textField>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_2}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="127" y="21" width="37" height="7" uuid="6664081c-30df-4e12-a563-e286fb71935a"/>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_3}]]></textFieldExpression>
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</textField>
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<textField>
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<reportElement x="127" y="26" width="37" height="7" uuid="e957833e-54e9-4145-b41b-1a72d0ddadf3"/>
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<textElement verticalAlignment="Middle">
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_4}]]></textFieldExpression>
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</textField>
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<textField>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_5}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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</textElement>
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<textFieldExpression><![CDATA[$F{claim_to_6}]]></textFieldExpression>
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<textField>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_7}]]></textFieldExpression>
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<textField>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_8}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_9}]]></textFieldExpression>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_10}]]></textFieldExpression>
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<textField>
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<textElement>
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<font size="5" isBold="true"/>
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<textFieldExpression><![CDATA[$F{claim_to_11}]]></textFieldExpression>
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<reportElement x="135" y="87" width="86" height="52" uuid="68346dc5-8ea0-4119-846b-af63da9dc653"/>
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<datasetRun subDataset="LogoDataset" uuid="f9c33856-e20c-4c2f-a9fe-8a2bbef32985">
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<datasetParameter name="LOGO_FILENAME">
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<datasetParameterExpression><![CDATA[$F{network_logo_filename}]]></datasetParameterExpression>
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</datasetParameter>
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<dataSourceExpression><![CDATA[new net.sf.jasperreports.engine.data.JRBeanCollectionDataSource($P{networkLogosList})]]></dataSourceExpression>
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<jr:listContents height="52" width="86">
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<image hAlign="Center" vAlign="Middle" isUsingCache="true">
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<imageExpression><![CDATA[$F{image_stream}]]></imageExpression>
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<font size="5" isBold="true"/>
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<text><![CDATA[Pre-certification is required for
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Inpatient Hospitalization.
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Call MedCost 1.800.722.2157]]></text>
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|
||
<pageFooter>
|
||
<band splitType="Stretch"/>
|
||
</pageFooter>
|
||
<summary>
|
||
<band splitType="Stretch"/>
|
||
</summary>
|
||
</jasperReport>
|