| Name | Value |
|---|---|
| FORM FIELD REFERENCE | IB 837 TRANSMISSION |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA=$$NOPUNCT^IBCEF($P($G(IBXSAVE("PROVINF",IBXIEN,"C",1,9,1)),"^",4),1) |
| FORMAT CODE DESCRIPTION | Other Provider Secondary Qualifier 1. EI=EMPLOYER ID, SY=SSN, 0B=STATE LICENSE #, 1A=BLUE CROSS, 1B=BLUE SHIELD, 1C=MEDICARE PARTA or PARTB, 1D=MEDICAID, 1G=UPIN #, 1H=TRICARE, G2=COMMERCIAL # X5=STATE INDUSTRIAL ACCIDENT PROVIDER #, LU=LOCATION #, N5=PROVIDER PLAN NETWORK ID |