IB 837 TRANSMISSION (646)    IB FORM FIELD CONTENT (364.7)

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",1,1,2)),"^",3)
FORMAT CODE DESCRIPTION
Refering 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