| 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 | I $$FT^IBCEF(IBXIEN)'=7 S IBXDATA=$P($G(IBXSAVE("PROVINF",IBXIEN,"C",1,5,1)),U,3) |
| FORMAT CODE DESCRIPTION | Supervising Provider Secondary ID Qualifier EI=EMPLOYER, SY=SSN, 0B=STATE LICENSE NUMBER, 1A=BLUE CROSS, 1B=BLUE SHIELD, 1C=MEDICARE PARTA aqnd PARTB, 1D=MEDICAID, 1G=UPIN Number, 1H=TRICARE G2=COMMERCAIL NUMBER, X5=STATE INDUSTRIAL ACCIDENT PROVIDER NUMBER N5=PROVIDER PLAN NETWORK ID |