| 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 | N IBX,IBY,IBZ S IBY=$$PRTLID^IBCEF77(IBXIEN,$G(IBXSAVE("NPIBILL"))) K IBXSAVE("NPIBILL"),IBXDATA I IBY D ALLIDS^IBCEF75(IBXIEN,.IBZ,1) S IBX=$G(IBZ("BILLING PRV",IBXIEN,"C",1,2)),IBXDATA=$P(IBX,U,1)_$P(IBX,U,2) |
| FORMAT CODE DESCRIPTION | 1500 form. Box 33b. Billing provider Other ID number. Enter the 2 digit qualifier followed by the secondary ID#. |