| Parent File | Name | Number | Package |
|---|---|---|---|
| IB SITE PARAMETERS(#350.9) | PAY-TO PROVIDERS | 350.9004 | Integrated Billing |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | FACILITY | 0;1 | POINTER TO INSTITUTION FILE (#4) | INSTITUTION(#4)
|
| .02 | NAME | 0;2 | FREE TEXT | ************************REQUIRED FIELD************************
|
| .03 | FEDERAL TAX NUMBER | 0;3 | FREE TEXT |
|
| .04 | TELEPHONE NUMBER | 0;4 | FREE TEXT |
|
| .05 | PARENT PAY-TO PROVIDER | 0;5 | NUMBER |
|
| 1.01 | STREET ADDRESS 1 | 1;1 | FREE TEXT |
|
| 1.02 | STREET ADDRESS 2 | 1;2 | FREE TEXT |
|
| 1.03 | CITY | 1;3 | FREE TEXT |
|
| 1.04 | STATE | 1;4 | POINTER TO STATE FILE (#5) | STATE(#5)
|
| 1.05 | ZIP | 1;5 | FREE TEXT |
|