._warning_14rff_1{color:var(--color-warning)}._warning_14rff_1>._warningHeader_14rff_4{margin-right:2cqw}._error_14rff_8{color:var(--color-warning)}._error_14rff_8>._errorHeader_14rff_11{margin-right:2cqw}._response_14rff_15{border:1px;border-color:#000;background-color:#eeebeb;border-radius:15px;padding:1em;margin-top:.5em}._groupDescription_14rff_24{margin-bottom:.5rem}._planGroupNumber_14rff_28{margin-left:.25rem}._wrapper_h877i_1{position:relative;display:flex;flex-direction:column}._wrapper_h877i_1 ._error_h877i_6{position:absolute;right:12px;top:50%;transform:translateY(-50%);color:var(--error-color);z-index:3}._wrapper_h877i_1._errorWide_h877i_14 ._error_h877i_6{right:2rem}._wrapper_h877i_1 ._label_h877i_17{position:absolute;left:12px;top:50%;transform:translateY(-50%);color:var(--text-color-help, #6c757d);font-size:var(--font-size, 16px);pointer-events:none;transition:all .2s;z-index:2}._wrapper_h877i_1 ._label_h877i_17 ._asterisk_h877i_28{color:var(--primary-color);margin-inline-start:4px;font-size:var(--font-size);font-family:SimSun,sans-serif;line-height:1}._wrapper_h877i_1 input:not(:-moz-placeholder)+._label_h877i_17,._wrapper_h877i_1 textarea:not(:-moz-placeholder)+._label_h877i_17{top:-4px;left:8px;font-size:12px;background:var(--neutral-white-color, #fff);padding:0 4px;transform:none}._wrapper_h877i_1 input:focus+._label_h877i_17,._wrapper_h877i_1 input:not(:placeholder-shown)+._label_h877i_17,._wrapper_h877i_1 textarea:focus+._label_h877i_17,._wrapper_h877i_1 textarea:not(:placeholder-shown)+._label_h877i_17,._wrapper_h877i_1 select:focus+._label_h877i_17,._wrapper_h877i_1 select:not([value=""])+._label_h877i_17,._wrapper_h877i_1 ._ant-picker-focused_h877i_41+._label_h877i_17,._wrapper_h877i_1 ._ant-picker_h877i_41 ._ant-picker-input_h877i_42>input[value]:not([value=""])+._label_h877i_17,._wrapper_h877i_1 ._active_h877i_43{top:-4px;left:8px;font-size:12px;background:var(--neutral-white-color, #fff);padding:0 4px;transform:none}._wrapper_h877i_1 ._label_h877i_17._small_h877i_51._active_h877i_43{font-size:10px}._section_1sfou_1{border-radius:6px;padding:.5rem;background-color:var(--mod-coverage-details-bg-color, #fafafa);margin-bottom:1rem}._physicianOrSupplierDivider_1sfou_8{margin-top:1rem}._fullWidth_1sfou_12{width:100%}._reservedForNuccField_1sfou_16{height:44px}._error_1sfou_20{position:absolute;top:5px;right:1rem;color:var(--error-color, #ff4d4f);padding-bottom:5px}._formRow_bul0f_1{margin-block:4px}._reservedForNuccField_bul0f_5{height:44px}._section_bul0f_9{border-radius:6px;padding:.5rem;background-color:var(--mod-coverage-details-bg-color, #fafafa);margin-bottom:1rem}._title_16l21_1{color:var(--text-color-help, #6c757d);padding-bottom:5px;overflow:hidden;white-space:nowrap;text-overflow:ellipsis}._title_16l21_1 ._asterisk_16l21_8{color:var(--primary-color);margin-inline-start:4px;font-size:var(--font-size);font-family:SimSun,sans-serif;line-height:1}._section_4y0d8_1{border-radius:6px;padding:.5rem;background-color:var(--mod-coverage-details-bg-color, #fafafa);margin-bottom:1rem}._fullWidth_4y0d8_8{width:100%}._provider_4y0d8_12 ._input_4y0d8_12 .ant-input{height:35px;line-height:35px;font-size:12px}._provider_4y0d8_12 ._npi_4y0d8_17,._provider_4y0d8_12 ._otherId_4y0d8_18{display:flex;flex-direction:row}._provider_4y0d8_12 ._npi_4y0d8_17{margin-top:4px}._provider_4y0d8_12 ._npi_4y0d8_17 ._field_4y0d8_25{width:100%}._provider_4y0d8_12 ._title_4y0d8_28{color:var(--text-color-help, #6c757d);margin-right:.5rem;display:flex;align-items:center}._section_kqbqi_1{border-radius:6px;padding:.5rem;background-color:var(--mod-coverage-details-bg-color, #fafafa);margin-bottom:1rem}._fullWidth_kqbqi_8{width:100%}._diagnosis_kqbqi_12 ._icd_kqbqi_12{margin-left:auto}._diagnosis_kqbqi_12 ._icd_kqbqi_12 .ant-select{height:35px;line-height:35px}._diagnosis_kqbqi_12 ._icd_kqbqi_12 .ant-select .ant-select-selector{font-size:12px}._diagnosis_kqbqi_12 .ant-select{height:40px;line-height:40px}._diagnosis_kqbqi_12 ._list_kqbqi_26{margin-top:4px}._diagnosis_kqbqi_12 ._error_kqbqi_29{color:var(--error-color, #ff4d4f);padding-bottom:5px}._diagnose_kqbqi_34{display:flex;flex-direction:row;margin-bottom:4px}._diagnose_kqbqi_34 ._field_kqbqi_39{width:100%}._diagnose_kqbqi_34 ._pointer_kqbqi_42{color:var(--text-color-help, #6c757d);min-width:1rem;display:flex;align-items:center}._scrollContainer_8x184_1{width:100%;overflow-x:auto}._table_8x184_6{border-collapse:collapse;width:100%;color:var(--text-color-help, #6c757d)}._table_8x184_6 th,._table_8x184_6 td{font-weight:400;border:1px solid #bbb;padding:4px;text-align:center;vertical-align:middle}._smallInput_8x184_20{width:3rem}._familyPlan_8x184_24{width:7rem}._divider_8x184_28{margin-block:4px}._npi_8x184_32{height:30px}._qualifier_8x184_36 .ant-select{height:30px;line-height:30px}._qualifier_8x184_36 .ant-select .ant-select-selector{font-size:12px}._providerId_8x184_44 .ant-input{height:30px;line-height:30px;font-size:12px}._addBtn_8x184_50{margin-top:1rem}._minWidthInput_8x184_54{min-width:10rem}._section_1u3nf_1{border-radius:6px;padding:.5rem;background-color:var(--mod-coverage-details-bg-color, #fafafa);margin-bottom:1rem}._formRow_1u3nf_8{margin-block:4px}._reservedForNuccField_1u3nf_12{height:44px}._insuranceSelect_11lqv_1,._referenceCheckbox_11lqv_5{width:100%}._selectionRow_11lqv_9{width:100%;margin-top:.5em}