FORM FIELD REFERENCE | SECURITY LEVEL | DATA ELEMENT | SCREEN PROMPT | INSURANCE COMPANY | BILL TYPE | PAD CHARACTER | REQUIRED | EDIT STATUS | EDIT GROUP NUMBER | FORMAT CODE | FORMAT CODE DESCRIPTION |
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CMS-1500 | Move the text over to the column specified in the 1500 ADDRESS COLUMN parameter (file 350.9, field 1.27). Also initialize utility globals and variables used in this form. 3/30/09 - IB patch 400 - Set the claim into the scratch global which indicates this claim is currently being printed as a CMS-1500 claim form. | ||||||||||
CMS-1500 | If the 1500 ADDRESS COLUMN parameter exists, move the text over to this column by adding spaces at the start of it. Save the indent parameter in IBXSAVE("INDENT") for future use. If the current insurance is MEDICARE WNR, output 'MEDICARE'. | ||||||||||
CMS-1500 | If the 1500 ADDRESS COLUMN parameter exists, move the text over to this column by adding spaces at the start of it. Format the address so each street address occupies one line, then a line containing city followed by a comma and space, the state abbreviation, a space and the zip code, formatted for zip plus 4 if appropriate. | ||||||||||
CMS-1500 | Check appropriate box for type of insurance. CMS-1500, Box 1. Possibility of checking one box. FECA BLK LUNG is not an available selection. Choices are mainly extracted from the ELECTRONIC PLAN TYPE field (#.15) in FILE# 355.3. Also used for the Group Health Plan box is the 3.09 field in file 36 (if the value is 5). Code is basically setting IBXDATA=$J("",[some offset amount])_"X". | ||||||||||
CMS-1500 | 1500 form, Box 1a. Current insurance insured's ID number. | ||||||||||
CMS-1500 | 1500 form, Box 2. Patient Name | ||||||||||
CMS-1500 | Format the date as MM DD YYYY. | ||||||||||
CMS-1500 | Save the value of patient sex in IBXSAVE variable for later use. If the value is 'M', this field's value is 'X'. | ||||||||||
CMS-1500 | This field relies on the existence of variable IBXSAVE("SEX") previously extracted. If its value is not 'M', assume the sex is female and this field's value will be 'X'. | ||||||||||
CMS-1500 | Save the insured's demographic data in IBXSAVE("IDEM"). |