IB 837 TRANSMISSION (1003)    IB FORM FIELD CONTENT (364.7)

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.