| Name | Value |
|---|---|
| FORM FIELD REFERENCE | CMS-1500 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA=$$GETPRV^IBCEF83(IBXIEN,,1,"B1") I IBXDATA="" S IBXDATA=$$GETPRV^IBCEF83(IBXIEN,,5,"B1") |
| FORMAT CODE DESCRIPTION | cms-1500, box 17a/1, 2 character qualifier for the Referring provider other ID (non-NPI ID). |