ELECTRONIC PLAN TYPE (29)    IB PROVIDER ID # TYPE (355.97)

Name Value
NAME ELECTRONIC PLAN TYPE
SOURCE LEVEL MINIMUM FACILITY - ALL PROV
X12 CODE 1J
VALID FOR PERFORMING PROVIDER NO
ALLOWABLE FORM TYPE INSTITUTIONAL
ACTIVE YES
PROVIDER'S OWN ID NO
STORED OUTSIDE OF BILLING NO
BILLING PROVIDER PRIMARY ID YES