| Name | Value |
|---|---|
| NAME | UB-04 |
| ROUTINE | EN^IBCF3 |
| BASE FILE | BILL/CLAIMS |
| FORMAT TYPE | PRINTED FORM |
| FORM LENGTH | 66 |
| NATIONAL FORM | YES |
| SHORT DESCRIPTION | NATIONAL UB-04 |
| PRINT FORM NAME | UB-04 |
| ENTRY PRE-PROCESSOR | D ENTPRE^IBCFP1 |
| ENTRY POST-PROCESSOR | D ENTPOST^IBCFP1 |
| EXTRACT CODE | D QB1^IBCFP1 |
| FORM PRE-PROCESSOR | D FORMPRE^IBCFP1 |
| FORM POST-PROCESSOR | D FORMPOST^IBCFP1 |