UB-04 (1263)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE UB-04
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-GET FROM PREVIOUS EXTRACT
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE S IBXDATA=$P($G(IBXSAVE("UBFL2")),U,8)
FORMAT CODE DESCRIPTION
UB-04, FL-2
pay-to provider state code