| Name | Value |
|---|---|
| FORM FIELD REFERENCE | LEGACY HCFA-1500 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-CURR INSURANCE CO PROV # |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | N IBZ S IBZ=$$WNRBILL^IBEFUNC(IBXIEN,+$$COBN^IBCEF(IBXIEN)) S:IBZ IBXDATA="VA0"_$P($$SITE^VASITE,U,3) |
| FORMAT CODE DESCRIPTION | If MRA is needed, use default of VA0 and the site #. For other than MRA, use the provider number assigned to the site by the insurance co. |