| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-ALL INSURED FULL NAMES |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | N Z F Z=1:1:3 I $G(IBXDATA(Z))'="",IBXDATA(Z)'["," S Q=$$NAME^IBCEFG1(IBXDATA(Z),1),IBXDATA(Z)=$P(Q,U)_$S($P(Q,U,2)'="":","_$P(Q,U,2),1:"") |