UB-04 (1316)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE UB-04
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-VALUE CODES
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE N Z,Z0,Z1 S Z=0 F S Z=$O(IBFL(39,Z)) K:'Z IBFL(39) Q:'Z S Z0=$P(IBFL(39,Z),U,2),Z1=$P(IBFL(39,Z),U,3),IBXSAVE("VC",Z)=$P(IBFL(39,Z),U,1)_U_$S(Z1:$$DOL^IBCEF77(Z0,10),1:$J(Z0,8))
FORMAT CODE DESCRIPTION
Save all value codes extracted into IBXSAVE("VC") array for later use.  
Non-dollar amounts are formatted right-justified to the left of the 
dollars/cents delimiter on the pre-printed UB form (thus 8 characters).
Format the value as we loop through them.
 
IBXSAVE("VC",z) = [1] VALUE CODE
                  [2] FORMATTED VALUE AMOUNT
 
Dollar amounts are formatted using all 10 characters with the decimal 
point implied by the dollars/cents delimiter on the pre-printed UB form.