UB-04 (1340)    IB FORM FIELD CONTENT (364.7)

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'.