LEGACY HCFA-1500 (799)    IB FORM FIELD CONTENT (364.7)

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.