| Name | Value |
|---|---|
| FORM FIELD REFERENCE | LEGACY UB-92 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-GET FROM PREVIOUS EXTRACT |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | D:'$D(IBXSAVE("PRV-82")) BOX82NM^IBCEU4(IBXIEN,.IBXSAVE) K IBXDATA S IBXDATA=$E($G(IBXSAVE("PRV-82",4)),1,30+$G(^TMP("IBXSAVE",$J,"RM"))) |
| FORMAT CODE DESCRIPTION | If not already done, extract all the possible providers into the appropriate line for box 82 on the UB-92 print claim form. This is the fourth line extracted. |