| 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=$$GETPRV^IBCEF83(IBXIEN,,1,"B2") I IBXDATA="" S IBXDATA=$$GETPRV^IBCEF83(IBXIEN,,5,"B2") |
| FORMAT CODE DESCRIPTION | CMS-1500, Box 17a/2, Referring Provider other ID number (non NPI ID number). |