CMS-1500 (1204)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE CMS-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-BILLING PROVIDER
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE N Z S Z=$P(IBXDATA,U,3),IBXSAVE("SERVFACFLAG")=$S(Z="":0,1:1),IBXSAVE("BPSFDATA")=IBXDATA D GETBP^IBCEF79(IBXIEN,"",+IBXDATA,"BOX33",.IBXSAVE)
FORMAT CODE DESCRIPTION
Calculate only field to populate boxes 32 and 33 on the CMS-1500 claim 
 
The IBXSAVE("BOX33") array elements will be built with information about 
the billing provider name, address, and phone# to go into Box 33.
form.  The data element call to N-BILLING PROVIDER will save information 
about the service facility and the billing provider for this claim.
 
IBXSAVE("SERVFACFLAG") is a 0/1 flag indicating if there is a service 
facility for this claim.
 
IBXSAVE("BPSFDATA") is the string of information returned by the 
$$B^IBCEF79 function call.