| Name | Value |
|---|---|
| FORM FIELD REFERENCE | IB 837 TRANSMISSION |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-RECORD ID |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA="OPR5" |
| FORMAT CODE DESCRIPTION | Referring Provider Secondary ID and Qualifier. 0B=STATE LICENSE #, 1B=BLUE SHILED #, 1C=MEDICARE #, 1D=MEDICAID # 1G=UPIN #, 1H=TRICARE ID #, G2=COMMERCIAL #, X5=STATE INDUSTRIAL ACCIDENT PROVIDER # LU=LOCATION # |