| 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(IBXSAVE("BOX 78"),U,2) |
| FORMAT CODE DESCRIPTION | Other provider legacy ID qualifier if needed |