| Name | Value |
|---|---|
| FORM FIELD REFERENCE | UB-04 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA=$P($P(IBXSAVE("BOX 79"),U,1),",",2) K IBXSAVE("BOX 79"),IBXPROV |
| FORMAT CODE DESCRIPTION | OTHER PROVIDER FIRST NAME |