| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-PRIOR PAYMENTS |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | N Z F Z=1:1:3 K:'$D(^DGCR(399,IBXIEN,"I"_Z)) IBXDATA(Z) I $D(IBXDATA(Z)) S IBXDATA(Z)=$$DOL^IBCEF77(IBXDATA(Z),10) |
| FORMAT CODE DESCRIPTION | If the insurance company for the prior payment does not exist for the bill, don't output the prior payment information. |