Global: ^IBA(364.7

FileMan FileNo	FileMan Filename	Package
364.7	IB FORM FIELD CONTENT	Integrated Billing

FileMan FileNo

FileMan Filename

Package

364.7

IB FORM FIELD CONTENT

Integrated Billing

Description

DO NOT delete entries or edit data in this file with VA File Manager. This is the file that contains the specific fields to be used to produce the associated form or screen. If there is no insurance company or bill type specified for an entry, this is assumed to be the default definition of the field. Entries in this file that are designated as having a SECURITY LEVEL of NATIONAL should not be deleted or edited.

Package	Total	Routines
Integrated Billing	26	IB20P109 IB20P207 IB20P350 IB20P644 IB488PRE IBCEFG4 IBCEFG41 IBCEFG5 IBCEFG6 IBCEFG60 IBCEFG61 IBCEU4 IBY232PO IBY280PR IBY296PR IBY320PR IBY323PR IBY349PR IBY371PR IBY400PR IBY403PR IBY447PR IBYOPOST IBYOPRE IBYPPCC IBYPPR

Package	Total	FileMan Files
Integrated Billing	3	INSURANCE COMPANY(#36)[.05] IB DATA ELEMENT DEFINITION(#364.5)[.03] IB FORM SKELETON DEFINITION(#364.6)[.01]

Fields, Total: 12

Field #	Name	Loc	Type	Details
.01	FORM FIELD REFERENCE	0;1	POINTER TO IB FORM SKELETON DEFINITION FILE (#364.6)	**********************REQUIRED FIELD********************** IB FORM SKELETON DEFINITION(#364.6) LAST EDITED: `APR 28, 2000` HELP-PROMPT: `Enter the billing form that this field is associated with` DESCRIPTION: `This is a pointer to the billing form field that this field is associated with.` CROSS-REFERENCE: `364.7^B` `1)= S ^IBA(364.7,"B",$E(X,1,30),DA)=""` `2)= K ^IBA(364.7,"B",$E(X,1,30),DA)` CROSS-REFERENCE: `364.7^ATYPE^MUMPS` `1)= N Z1,Z0 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,6) I Z1'="",$P($G(^IBA(364.6,+X,0)),U,3),'$P(Z0,U,5) S ^IBA(364.7,"ATYPE",$P(^IBA(364.6,+X,0),U,3),Z1,DA)=""` `2)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,6) I Z1'="",$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"ATYPE",$P(^IBA(364.6,+X,0),U,3),Z1,DA)` `3)= DO NOT DELETE` `Xref by form and bill type` CROSS-REFERENCE: `364.7^AINTYP^MUMPS` `1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5),Z2=$P(Z0,U,6) I Z1,Z2'="",$P($G(^IBA(364.6,+X,0)),U,3) S ^IBA(364.7,"AINTYP",$P(^IBA(364.6,+X,0),U,3),Z1,Z2,DA)=""` `2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5),Z2=$P(Z0,U,6) I Z1,Z2'="",$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"AINTYP",$P(^IBA(364.6,+X,0),U,3),Z1,Z2,DA)` `3)= DO NOT DELETE` `Xref by form, insurance company and bill type` CROSS-REFERENCE: `364.7^AINS^MUMPS` `1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5) I Z1,$P($G(^IBA(364.6,+X,0)),U,3),$P(Z0,U,6)="" S ^IBA(364.7,"AINS",$P(^IBA(364.6,+X,0),U,3),Z1,DA)=""` `2)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P(Z0,U,5) I Z1,$P($G(^IBA(364.6,+X,0)),U,3) K ^IBA(364.7,"AINS",$P(^IBA(364.6,+X,0),U,3),Z1,DA)` `3)= DO NOT DELETE` `Xref by form field and insurance company` FIELD INDEX: `ALL (#52) MUMPS IR SORTING ONLY` `Short Descr: Xref contains all local overrides defined for all insurance and type` `Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""` `Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0` `Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)` `Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0` `Whole Kill: K ^IBA(364.7,"ALL")` `X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)` `Transform (Display):` `X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)` `(Subscr 1) (Len 10)` `X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)` `Transform (Display):` `X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)` `Transform (Display):` `X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)` `Transform (Display):`
.02	SECURITY LEVEL	0;2	SET	'N' FOR NATIONAL,NO EDIT; 'L' FOR LOCAL; LAST EDITED: `APR 28, 2000` HELP-PROMPT: `Enter N for nationally released fields (no edit) or L for locally added fields.` DESCRIPTION: `This field determines whether or not editing of the entry is allowed. For NATIONAL (N) field, no local editing is allowed. If LOCAL (L) field is created, editing is allowed.` FIELD INDEX: `ALL (#52) MUMPS IR SORTING ONLY` `Short Descr: Xref contains all local overrides defined for all insurance and type` `Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""` `Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0` `Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)` `Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0` `Whole Kill: K ^IBA(364.7,"ALL")` `X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)` `Transform (Display):` `X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)` `(Subscr 1) (Len 10)` `X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)` `Transform (Display):` `X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)` `Transform (Display):` `X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)` `Transform (Display):`
.03	DATA ELEMENT	0;3	POINTER TO IB DATA ELEMENT DEFINITION FILE (#364.5)	IB DATA ELEMENT DEFINITION(#364.5) LAST EDITED: `JUL 02, 1996` HELP-PROMPT: `Enter the data element that will define this form field. If used on a screen, it must be a fileman type.` DESCRIPTION: `This identifies the data element that be extracted for this entry.` TECHNICAL DESCR: `This is the data element that will be allowed to be displayed/edited on a screen, extracted for a transmit, or printed on a printed form. If used on a screen, the data element must be a fileman type and a local field` `(>10000 for ifn and on a node >10000) to be editable.` CROSS-REFERENCE: `364.7^C` `1)= S ^IBA(364.7,"C",$E(X,1,30),DA)=""` `2)= K ^IBA(364.7,"C",$E(X,1,30),DA)` `3)= DO NOT DELETE` `Xref by DATA ELEMENT NAME`
.04	SCREEN PROMPT	0;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>70!($L(X)<1) X I $D(X),$P($G(^IBE(353,+$G(^IBA(364.6,+$G(^IBA(364.7,DA,0)),0)),2)),U,2)'="S" K X` LAST EDITED: `MAR 21, 1996` HELP-PROMPT: `Answer must be 1-70 characters in length.` DESCRIPTION: `This is used only by screen-type forms to place a prompt on the screen for a particular field.` TECHNICAL DESCR: `This is the prompt that will preceed the data element defined for this entry. If no data element, this prompt will display. This field is only used for screen-type forms.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
.05	INSURANCE COMPANY	0;5	POINTER TO INSURANCE COMPANY FILE (#36)	INSURANCE COMPANY(#36) LAST EDITED: `APR 28, 2000` HELP-PROMPT: `Enter the name of the insurance company that this field is associated with.` DESCRIPTION: `This is the insurance company who has a need for other than the standard data in this field.` CROSS-REFERENCE: `364.7^AINS1^MUMPS` `1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3) I Z1,$P(Z0,U,6)="" S ^IBA(364.7,"AINS",Z1,$E(X,1,30),DA)=""` `2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) K ^IBA(364.7,"AINS",Z1,$E(X,1,30),DA) I Z2'="",$D(^IBA(364.7,"AINTYP",Z1,X,Z2,DA)) S ^IBA(364.7,"ATYPE",Z1,Z2,DA)=""` `3)= DO NOT DELETE` `Xref by form field and insurance company.` CROSS-REFERENCE: `364.7^AINTYP1^MUMPS` `1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) I Z1,Z2'="" S ^IBA(364.7,"AINTYP",Z1,$E(X,1,30),Z2,DA)="" K ^IBA(364.7,"ATYPE",Z1,Z2,DA),^IBA(364.7,"AINS",Z1,X,DA)` `2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,6) K:Z1&(Z2'="") ^IBA(364.7,"AINTYP",Z1,$E(X,1,30),Z2,DA)` `3)= DO NOT DELETE` `Xref by insurance company and bill type` FIELD INDEX: `ALL (#52) MUMPS IR SORTING ONLY` `Short Descr: Xref contains all local overrides defined for all insurance and type` `Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""` `Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0` `Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)` `Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0` `Whole Kill: K ^IBA(364.7,"ALL")` `X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)` `Transform (Display):` `X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)` `(Subscr 1) (Len 10)` `X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)` `Transform (Display):` `X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)` `Transform (Display):` `X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)` `Transform (Display):`
.06	BILL TYPE	0;6	SET	'I' FOR INPATIENT; 'O' FOR OUTPATIENT; LAST EDITED: `APR 28, 2000` HELP-PROMPT: `Enter the type of the bill.` DESCRIPTION: `This is the type of bill that requires this field.` CROSS-REFERENCE: `364.7^ATYPE1^MUMPS` `1)= N Z0,Z1 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3) I Z1,'$P(Z0,U,5) S ^IBA(364.7,"ATYPE",Z1,$E(X,1,30),DA)=""` `2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) I Z1 K ^IBA(364.7,"ATYPE",Z1,$E(X,1,30),DA) I Z2,$D(^IBA(364.7,"AINTYP",Z1,Z2,X,DA)) S ^IBA(364.7,"AINS",Z1,Z2,DA)=""` `3)= DO NOT DELETE` `Xref by form and bill type.` CROSS-REFERENCE: `364.7^AINTYP2^MUMPS` `1)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) I Z1,Z2 K:'$D(^IBA(364.7,"AINTYP",Z1,Z2,X,DA)) ^IBA(364.7,"AINS",Z1,Z2,DA) S ^IBA(364.7,"AINTYP",Z1,Z2,$E(X,1,30),DA)=""` `2)= N Z0,Z1,Z2 S Z0=$G(^IBA(364.7,DA,0)),Z1=+$P($G(^IBA(364.6,+Z0,0)),U,3),Z2=$P(Z0,U,5) K:Z1&Z2 ^IBA(364.7,"AINTYP",Z1,Z2,$E(X,1,30),DA)` `3)= DO NOT DELETE` `Xref by form, insurance company and bill type` FIELD INDEX: `ALL (#52) MUMPS IR SORTING ONLY` `Short Descr: Xref contains all local overrides defined for all insurance and type` `Set Logic: S ^IBA(364.7,"ALL",X2(2),DA)=""` `Set Cond: I 'X2(2)!(X2(4)'="")!(X2(5)'="")!(X2(3)'="L") S X=0` `Kill Logic: K ^IBA(364.7,"ALL",X1(2),DA)` `Kill Cond: I 'X1(2)!(X1(4)'="")!(X1(5)'="")!(X1(3)'="L") S X=0` `Whole Kill: K ^IBA(364.7,"ALL")` `X(1): FORM FIELD REFERENCE (364.7,.01) (Len 15) (forwards)` `Transform (Display):` `X(2): Computed Code: S X=$P($G(^IBA(364.6,+X(1),0)),U,3)` `(Subscr 1) (Len 10)` `X(3): SECURITY LEVEL (364.7,.02) (Len 10) (forwards)` `Transform (Display):` `X(4): INSURANCE COMPANY (364.7,.05) (Len 20) (forwards)` `Transform (Display):` `X(5): BILL TYPE (364.7,.06) (Len 20) (forwards)` `Transform (Display):`
.07	PAD CHARACTER	0;7	SET	'ZL' FOR ZERO PAD ON LEFT; 'ZR' FOR ZERO PAD ON RIGHT; 'SL' FOR SPACE PAD ON LEFT; 'SR' FOR SPACE PAD ON RIGHT; 'N' FOR NO PAD REQUIRED; LAST EDITED: `JAN 26, 1996` HELP-PROMPT: `Enter the code that corresponds to the format and pad character to use for the data output in this field.` DESCRIPTION: `If present, this defines the character to be used to pad the DATA ELEMENT to its desired length and the orientation of the padding characters to the left or right of the data. The default is space pad to the right.`
.08	REQUIRED	0;8	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `DEC 07, 1995` HELP-PROMPT: `Enter 1 (YES) if this data element is on a local screen 9 form and the data is required for the bill to be authorized.` DESCRIPTION: `This field controls the required/not required status of a data element on a local screen 9 form. If this field is 1 (YES), this data element is always required to have data (not null) in order for a bill to be authorized.`
.09	EDIT STATUS	0;9	SET	'E' FOR EDITABLE; 'D' FOR DISPLAY ONLY; LAST EDITED: `MAR 20, 1996` HELP-PROMPT: `Enter 'E' to enable editing for this field, 'D' for a display only field.` DESCRIPTION: `This field is used to control whether or not a data element on a screen is editable or for display-only purposes.`
.1	EDIT GROUP NUMBER	0;10	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X` LAST EDITED: `MAR 21, 1996` HELP-PROMPT: `Enter the edit group # that this field will be included in. Valid #'s are 1-99.` DESCRIPTION: `This field contains the # of the edit group that the screen data element will be included with. When this group # is selected on an edit screen, all data elements assigned to this group # on this screen will be presented` `for editing. If no # is entered here, this field will not be available for editing. This field will only apply to screen-type forms' editable data element descriptions.`
1	FORMAT CODE	1;E1,245	MUMPS	INPUT TRANSFORM: `K:$L(X)>245 X D:$D(X) ^DIM` LAST EDITED: `DEC 07, 1995` HELP-PROMPT: `This is Standard MUMPS code.` DESCRIPTION: `This is the code that will be xecuted to format the 'raw' data element value that is returned from the execution of the DATA ELEMENT's definition. This code can assume the variable/array IBXDATA is available as input and` `should set this variable/array as its output. Standard calls for data formatting have been provided. The variables IBXPG, IBXLN, IBXCOL are the only IBX* variables that should be changed in this routine. These represent` `the page, line, column as the first 3 levels of subscript for the output array.` `WRITE AUTHORITY: @`
3	FORMAT CODE DESCRIPTION	3;0	WORD-PROCESSING #364.73	LAST EDITED: `JUL 10, 1996` DESCRIPTION: `This field describes the function of the format code entered.` LAST EDITED: `JUL 10, 1996` HELP-PROMPT: `Enter a description of the processing logic of the format code.` DESCRIPTION: `This is a description of the processing logic of the format code.`

FORM FIELD REFERENCE: 364.6^1^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^4^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^6^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^7^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^3^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^9^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^10^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^11^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^12^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^13^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1015^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1016^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^17^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^16^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^18^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^22^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^26^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^27^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^28^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^60^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^61^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^92^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^56^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^59^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^76^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^75^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^42^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^139^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^86^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^85^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^87^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^93^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^29^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^31^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^30^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^32^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^140^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^67^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^47^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^141^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^81^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^82^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^58^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^945^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^38^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^35^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^36^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^37^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^33^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^34^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^39^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^40^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^41^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^43^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^64^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^44^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^45^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^46^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^48^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^66^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^83^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^84^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^49^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^50^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^51^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^52^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^53^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^54^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^159^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^156^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^155^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^153^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^152^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^151^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^150^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1029^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1030^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^147^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^146^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^145^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^144^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^70^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^73^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^71^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^72^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^142^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^55^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^143^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^57^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^62^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^63^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^91^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^88^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^161^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^89^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1031^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^74^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^95^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^96^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^97^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^98^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^100^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^99^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^162^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^101^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^102^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^103^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^163^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^164^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^108^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^109^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^110^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^165^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^166^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^2465^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^192^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^65^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^190^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^189^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^133^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^134^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^137^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^135^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^136^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^138^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1032^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^178^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^181^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^179^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^180^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^183^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^2466^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^186^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^185^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^187^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^188^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^193^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^170^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^171^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^600^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^173^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^174^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^167^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^168^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^169^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^106^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^112^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^113^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^114^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^115^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^116^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^117^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^118^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^119^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^120^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^121^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^122^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^123^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^124^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^126^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^127^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^130^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^128^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^129^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^131^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^132^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^194^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1033^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^195^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^125^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^197^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^198^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1034^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1035^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^175^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^196^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1036^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1037^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1038^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^209^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^215^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^216^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^217^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1039^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1041^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1042^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1043^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1044^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1045^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1046^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1047^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1048^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^206^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^207^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^210^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^212^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^213^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^214^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^230^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1051^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^226^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^227^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1056^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1057^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1058^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^240^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1059^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^242^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^243^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^244^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^245^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^246^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^249^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^250^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^251^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^252^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^253^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1060^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1061^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1062^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1063^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^489^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^490^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^576^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^495^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^496^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^497^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1065^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^498^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^499^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^500^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^501^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^502^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^503^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^504^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^505^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^506^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^507^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^508^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^509^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^510^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^511^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^512^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^513^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^514^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^515^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^516^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^517^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^518^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^519^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^520^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^521^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^522^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^523^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^524^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^525^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^526^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^527^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^528^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^529^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^530^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^531^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^532^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^533^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^534^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^535^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^536^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^537^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^538^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^539^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^540^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^541^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^542^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^546^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^543^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^544^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^548^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^547^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^549^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^550^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^551^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^552^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^562^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^563^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^564^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^565^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^567^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^568^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^569^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^584^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^585^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^570^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^571^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1072^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^572^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^589^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^590^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^591^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^573^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^574^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1073^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1074^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^592^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^554^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^555^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^556^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^557^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^558^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^559^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^560^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^561^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^593^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^545^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^594^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^595^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^566^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^596^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^597^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^598^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^599^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^601^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^602^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^603^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^604^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1075^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1076^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1077^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1081^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1082	FORM FIELD REFERENCE: 364.6^1083	FORM FIELD REFERENCE: 364.6^1085	FORM FIELD REFERENCE: 364.6^1086	FORM FIELD REFERENCE: 364.6^1087	FORM FIELD REFERENCE: 364.6^1088	FORM FIELD REFERENCE: 364.6^1089	FORM FIELD REFERENCE: 364.6^1090
FORM FIELD REFERENCE: 364.6^1091	FORM FIELD REFERENCE: 364.6^1094^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1095^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1096^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1189^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1190^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1192^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1191^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^172^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1194^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1207^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1209^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1210^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1211^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1212^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1213^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1219^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1220^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1221^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1222^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1223^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1224^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1225^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1226^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1227^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1228^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1229^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1230^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1231^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1234^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1235^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1236^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1237^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1238^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1239^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1240^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1241^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1245^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1218^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1277^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1278^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1279^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1280^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1281^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1282^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1283^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1284^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1287^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1288^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1289^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1290^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1291^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1292^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1293^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1294^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1295^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1116^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1126^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1135^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1162^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^488^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^479^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^481^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^483^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^582^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^583^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^580^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^581^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^579^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^605^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^606^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^607^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^608^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1171^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^610^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^611^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^612^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^613^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^614^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^615^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^616^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^617^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^618^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^619^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^620^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^621^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^622^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^623^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^624^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^625^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^626^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^627^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^628^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^629^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^630^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^631^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^632^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^633^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^634^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^635^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^636^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^637^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^638^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^639^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^640^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^641^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^642^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^643^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^644^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^645^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^646^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^647^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^648^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^649^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^650^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^651^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^652^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1180^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1300^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^655^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^656^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1182^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^658^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1107^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1113^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^661^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1115^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1108^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1111^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1110^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1112^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1118^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1119^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1121^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1123^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1120^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1124^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1117^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1128^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1131^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1129^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1133^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1130^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1132^IB 837 TRANSMISSION
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FORM FIELD REFERENCE: 364.6^1177^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1179^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1172^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1183^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1185^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1187^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1184^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1186^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1188^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^728^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^729^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^730^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^731^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^732^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^733^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^734^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^735^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^736^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^737^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^738^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^739^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^740^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^741^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^742^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^743^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^744^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^745^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^746^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^747^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^748^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^749^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^750^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^751^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^752^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^753^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^754^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^755^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^756^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^757^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^758^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^759^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^760^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^761^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1181^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1106^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^765^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^1254^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1255^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1256^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1257^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1258^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1259^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1247^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1249^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1251^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1244^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1246^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1248^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1250^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1114^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1122^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^663^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^664^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^665^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^666^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^678^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^679^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^680^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^681^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^682^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^683^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^684^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^685^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^686^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^687^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^688^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^689^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^690^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^691^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^692^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^693^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^694^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^695^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^696^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^697^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^698^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^699^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^700^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^701^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^702^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^703^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^704^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^705^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^706^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^707^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^708^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^709^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^710^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^711^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^712^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^713^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^714^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^715^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^716^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^717^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^718^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^719^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^720^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^721^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^722^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^724^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^725^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^726^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^727^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^766^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^767^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^768^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^769^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^770^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^771^LEGACY UB-92
FORM FIELD REFERENCE: 364.6^772^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^774^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^775^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^777^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^781^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^778^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^779^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^780^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^782^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^784^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^785^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^943^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^788^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^789^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^790^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^791^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^807^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^808^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^864^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^793^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^885^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^886^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^809^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^816^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^827^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^839^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^853^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^817^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^828^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^840^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^854^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^887^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^888^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^890^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^841^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^818^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^829^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^855^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^848^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^856^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^892^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^810^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^866^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^865^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^867^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^878^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^879^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^880^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^881^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^907^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^882^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^811^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^812^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^819^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^820^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^821^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^822^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^823^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^825^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^826^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^830^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^831^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^832^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^833^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^834^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^835^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^836^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^837^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^838^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^842^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^843^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^844^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^847^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^849^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^850^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^851^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^924^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^845^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^846^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^857^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^893^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^858^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^897^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^898^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^902^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^903^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^904^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^905^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^906^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^899^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^901^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^894^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^895^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^900^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^896^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^923^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^862^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^852^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^863^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^783^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^936^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^938^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^948^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^950^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^794^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^804^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^805^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^806^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^941^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^942^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^946^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^949^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^937^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^947^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^939^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^944^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^935^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^951^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^952^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^859^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^860^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^861^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^953^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^954^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^955^LEGACY UB-92	FORM FIELD REFERENCE: 364.6^956^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^957^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^958^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^960^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^959^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^965^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^967^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^795^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^977^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^978^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^979^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^980^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^981^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^982^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^177^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^796^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^970^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^971^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^972^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^974^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^975^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^968^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^868^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^869^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^870^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^871^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^872^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^873^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^874^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^875^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^876^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^877^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^976^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^883^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^912^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^908^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^909^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^910^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^921^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^911^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^914^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^918^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^920^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^913^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^919^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^915^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^917^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^916^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^884^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^983^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^985^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^986^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^988^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^993^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^991^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^992^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^994^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^996^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^995^LEGACY HCFA-1500
FORM FIELD REFERENCE: 364.6^999^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1000^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1001^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1002^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1004^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1005^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1006^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1007^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1008^LEGACY HCFA-1500	FORM FIELD REFERENCE: 364.6^1009^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1010^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1011^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1012^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1014^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1301^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1303^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1305^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1306^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1309^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1310^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1304^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1084	FORM FIELD REFERENCE: 364.6^1311	FORM FIELD REFERENCE: 364.6^1312^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^1313^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1314	FORM FIELD REFERENCE: 364.6^1315^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1316^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1317^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^973^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1318^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1319^IB 837 TRANSMISSION
FORM FIELD REFERENCE: 364.6^990^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1320^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1321^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1322^IB 837 TRANSMISSION	FORM FIELD REFERENCE: 364.6^1400^CMS-1500	FORM FIELD REFERENCE: 364.6^1401^CMS-1500	FORM FIELD REFERENCE: 364.6^1402^CMS-1500	FORM FIELD REFERENCE: 364.6^1403^CMS-1500
FORM FIELD REFERENCE: 364.6^1404^CMS-1500	FORM FIELD REFERENCE: 364.6^1405^CMS-1500	FORM FIELD REFERENCE: 364.6^1406^CMS-1500	FORM FIELD REFERENCE: 364.6^1407^CMS-1500	FORM FIELD REFERENCE: 364.6^1408^CMS-1500	FORM FIELD REFERENCE: 364.6^1409^CMS-1500	FORM FIELD REFERENCE: 364.6^1410^CMS-1500	FORM FIELD REFERENCE: 364.6^1411^CMS-1500
FORM FIELD REFERENCE: 364.6^1412^CMS-1500	FORM FIELD REFERENCE: 364.6^1413^CMS-1500	FORM FIELD REFERENCE: 364.6^1414^CMS-1500	FORM FIELD REFERENCE: 364.6^1415^CMS-1500	FORM FIELD REFERENCE: 364.6^1416^CMS-1500	FORM FIELD REFERENCE: 364.6^1417^CMS-1500	FORM FIELD REFERENCE: 364.6^1418^CMS-1500	FORM FIELD REFERENCE: 364.6^1419^CMS-1500
FORM FIELD REFERENCE: 364.6^1420^CMS-1500	FORM FIELD REFERENCE: 364.6^1421^CMS-1500	FORM FIELD REFERENCE: 364.6^1422^CMS-1500	FORM FIELD REFERENCE: 364.6^1423^CMS-1500	FORM FIELD REFERENCE: 364.6^1424^CMS-1500	FORM FIELD REFERENCE: 364.6^1425^CMS-1500	FORM FIELD REFERENCE: 364.6^1426^CMS-1500	FORM FIELD REFERENCE: 364.6^1427^CMS-1500
FORM FIELD REFERENCE: 364.6^1428^CMS-1500	FORM FIELD REFERENCE: 364.6^1429^CMS-1500	FORM FIELD REFERENCE: 364.6^1430^CMS-1500	FORM FIELD REFERENCE: 364.6^1431^CMS-1500	FORM FIELD REFERENCE: 364.6^1432^CMS-1500	FORM FIELD REFERENCE: 364.6^1433^CMS-1500	FORM FIELD REFERENCE: 364.6^1434^CMS-1500	FORM FIELD REFERENCE: 364.6^1435^CMS-1500
FORM FIELD REFERENCE: 364.6^1436^CMS-1500	FORM FIELD REFERENCE: 364.6^1437^CMS-1500	FORM FIELD REFERENCE: 364.6^1438^CMS-1500	FORM FIELD REFERENCE: 364.6^1439^CMS-1500	FORM FIELD REFERENCE: 364.6^1440^CMS-1500	FORM FIELD REFERENCE: 364.6^1441^CMS-1500	FORM FIELD REFERENCE: 364.6^1442^CMS-1500	FORM FIELD REFERENCE: 364.6^1443^CMS-1500
FORM FIELD REFERENCE: 364.6^1444	FORM FIELD REFERENCE: 364.6^1445^CMS-1500	FORM FIELD REFERENCE: 364.6^1446^CMS-1500	FORM FIELD REFERENCE: 364.6^1447^CMS-1500	FORM FIELD REFERENCE: 364.6^1448^CMS-1500	FORM FIELD REFERENCE: 364.6^1449^CMS-1500	FORM FIELD REFERENCE: 364.6^1450^CMS-1500	FORM FIELD REFERENCE: 364.6^1451^CMS-1500
FORM FIELD REFERENCE: 364.6^1452^CMS-1500	FORM FIELD REFERENCE: 364.6^1453^CMS-1500	FORM FIELD REFERENCE: 364.6^1454^CMS-1500	FORM FIELD REFERENCE: 364.6^1455^CMS-1500	FORM FIELD REFERENCE: 364.6^1456^CMS-1500	FORM FIELD REFERENCE: 364.6^1457^CMS-1500	FORM FIELD REFERENCE: 364.6^1458^CMS-1500	FORM FIELD REFERENCE: 364.6^1459^CMS-1500
FORM FIELD REFERENCE: 364.6^1460^CMS-1500	FORM FIELD REFERENCE: 364.6^1461^CMS-1500	FORM FIELD REFERENCE: 364.6^1462^CMS-1500	FORM FIELD REFERENCE: 364.6^1463^CMS-1500	FORM FIELD REFERENCE: 364.6^1464	FORM FIELD REFERENCE: 364.6^1465^CMS-1500	FORM FIELD REFERENCE: 364.6^1466^CMS-1500	FORM FIELD REFERENCE: 364.6^1467^CMS-1500
FORM FIELD REFERENCE: 364.6^1468^CMS-1500	FORM FIELD REFERENCE: 364.6^1469^CMS-1500	FORM FIELD REFERENCE: 364.6^1470^CMS-1500	FORM FIELD REFERENCE: 364.6^1471^CMS-1500	FORM FIELD REFERENCE: 364.6^1472^CMS-1500	FORM FIELD REFERENCE: 364.6^1473^CMS-1500	FORM FIELD REFERENCE: 364.6^1474^CMS-1500	FORM FIELD REFERENCE: 364.6^1475^CMS-1500
FORM FIELD REFERENCE: 364.6^1476^CMS-1500	FORM FIELD REFERENCE: 364.6^1477^CMS-1500	FORM FIELD REFERENCE: 364.6^1478^CMS-1500	FORM FIELD REFERENCE: 364.6^1479^CMS-1500	FORM FIELD REFERENCE: 364.6^1480^CMS-1500	FORM FIELD REFERENCE: 364.6^1481^CMS-1500	FORM FIELD REFERENCE: 364.6^1482^CMS-1500	FORM FIELD REFERENCE: 364.6^1483^CMS-1500
FORM FIELD REFERENCE: 364.6^1484^CMS-1500	FORM FIELD REFERENCE: 364.6^1485^CMS-1500	FORM FIELD REFERENCE: 364.6^1486^CMS-1500	FORM FIELD REFERENCE: 364.6^1487^CMS-1500	FORM FIELD REFERENCE: 364.6^1488^CMS-1500	FORM FIELD REFERENCE: 364.6^1489^CMS-1500	FORM FIELD REFERENCE: 364.6^1490^CMS-1500	FORM FIELD REFERENCE: 364.6^1491^CMS-1500
FORM FIELD REFERENCE: 364.6^1492^CMS-1500	FORM FIELD REFERENCE: 364.6^1493^CMS-1500	FORM FIELD REFERENCE: 364.6^1494^CMS-1500	FORM FIELD REFERENCE: 364.6^1495^CMS-1500	FORM FIELD REFERENCE: 364.6^1496^CMS-1500	FORM FIELD REFERENCE: 364.6^1497^CMS-1500	FORM FIELD REFERENCE: 364.6^1498^CMS-1500	FORM FIELD REFERENCE: 364.6^1499^CMS-1500
FORM FIELD REFERENCE: 364.6^1500^CMS-1500	FORM FIELD REFERENCE: 364.6^1501^CMS-1500	FORM FIELD REFERENCE: 364.6^1502^CMS-1500	FORM FIELD REFERENCE: 364.6^1503^CMS-1500	FORM FIELD REFERENCE: 364.6^1504^CMS-1500	FORM FIELD REFERENCE: 364.6^1505^CMS-1500	FORM FIELD REFERENCE: 364.6^1506^CMS-1500	FORM FIELD REFERENCE: 364.6^1507^CMS-1500
FORM FIELD REFERENCE: 364.6^1508^CMS-1500	FORM FIELD REFERENCE: 364.6^1509^CMS-1500	FORM FIELD REFERENCE: 364.6^1513^CMS-1500	FORM FIELD REFERENCE: 364.6^1514^CMS-1500	FORM FIELD REFERENCE: 364.6^1515^CMS-1500	FORM FIELD REFERENCE: 364.6^1516^CMS-1500	FORM FIELD REFERENCE: 364.6^1517^CMS-1500	FORM FIELD REFERENCE: 364.6^1518^CMS-1500
FORM FIELD REFERENCE: 364.6^1519^CMS-1500	FORM FIELD REFERENCE: 364.6^1520^CMS-1500	FORM FIELD REFERENCE: 364.6^1550^UB-04	FORM FIELD REFERENCE: 364.6^1551^UB-04	FORM FIELD REFERENCE: 364.6^1552^UB-04	FORM FIELD REFERENCE: 364.6^1553^UB-04	FORM FIELD REFERENCE: 364.6^1554^UB-04	FORM FIELD REFERENCE: 364.6^1555^UB-04
FORM FIELD REFERENCE: 364.6^1556^UB-04	FORM FIELD REFERENCE: 364.6^1557^UB-04	FORM FIELD REFERENCE: 364.6^1558^UB-04	FORM FIELD REFERENCE: 364.6^1559^UB-04	FORM FIELD REFERENCE: 364.6^1560^UB-04	FORM FIELD REFERENCE: 364.6^1561^UB-04	FORM FIELD REFERENCE: 364.6^1562^UB-04	FORM FIELD REFERENCE: 364.6^1563^UB-04
FORM FIELD REFERENCE: 364.6^1564^UB-04	FORM FIELD REFERENCE: 364.6^1565^UB-04	FORM FIELD REFERENCE: 364.6^1566^UB-04	FORM FIELD REFERENCE: 364.6^1567^UB-04	FORM FIELD REFERENCE: 364.6^1568^UB-04	FORM FIELD REFERENCE: 364.6^1569^UB-04	FORM FIELD REFERENCE: 364.6^1570^UB-04	FORM FIELD REFERENCE: 364.6^1571^UB-04
FORM FIELD REFERENCE: 364.6^1572^UB-04	FORM FIELD REFERENCE: 364.6^1573^UB-04	FORM FIELD REFERENCE: 364.6^1574^UB-04	FORM FIELD REFERENCE: 364.6^1575^UB-04	FORM FIELD REFERENCE: 364.6^1576^UB-04	FORM FIELD REFERENCE: 364.6^1577^UB-04	FORM FIELD REFERENCE: 364.6^1578^UB-04	FORM FIELD REFERENCE: 364.6^1579^UB-04
FORM FIELD REFERENCE: 364.6^1580^UB-04	FORM FIELD REFERENCE: 364.6^1581^UB-04	FORM FIELD REFERENCE: 364.6^1582^UB-04	FORM FIELD REFERENCE: 364.6^1583^UB-04	FORM FIELD REFERENCE: 364.6^1584^UB-04	FORM FIELD REFERENCE: 364.6^1585^UB-04	FORM FIELD REFERENCE: 364.6^1586^UB-04	FORM FIELD REFERENCE: 364.6^1587^UB-04
FORM FIELD REFERENCE: 364.6^1588^UB-04	FORM FIELD REFERENCE: 364.6^1589^UB-04	FORM FIELD REFERENCE: 364.6^1590^UB-04	FORM FIELD REFERENCE: 364.6^1591^UB-04	FORM FIELD REFERENCE: 364.6^1592^UB-04	FORM FIELD REFERENCE: 364.6^1593^UB-04	FORM FIELD REFERENCE: 364.6^1594^UB-04	FORM FIELD REFERENCE: 364.6^1595^UB-04
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Package: Integrated Billing

Global: ^IBA(364.7

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Description

Accessed By FileMan Db Calls, Total: 26

Pointer To FileMan Files, Total: 3

Fields, Total: 12

Found Entries, Total: 1688