UB-04 (1361)    IB FORM FIELD CONTENT (364.7)

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:"")