| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-ALL INSURANCE COMPANIES |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | N Z,Z0 M Z0=IBXDATA K IBXDATA S Z="" F S Z=$O(Z0(Z)) Q:'Z I $D(^DGCR(399,IBXIEN,"I"_Z)) S IBXDATA(Z)=$S(Z<3&$$WNRBILL^IBEFUNC(IBXIEN,Z):"MEDICARE",1:$P(Z0(Z),U)) |
| FORMAT CODE DESCRIPTION | The first 15 characters of the name of the primary, secondary, and tertiary insurance companies along with the claim office number and payer id, if known. If the primary or secondary insurance is MEDICARE WNR, output 'MEDICARE'. |