| Name | Value |
|---|---|
| FORM FIELD REFERENCE | IB 837 TRANSMISSION |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-HCFA 1500 BOX 19 |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | I $$FT^IBCEF(IBXIEN)'=2,$$FT^IBCEF(IBXIEN)'=7 K IBXDATA |
| FORMAT CODE DESCRIPTION | Claim must be a CMS-1500 claim for this to be transmitted. |