UB-04 (1554)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 4
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 1
LENGTH 12
SHORT DESCRIPTION BILL PROVIDER CITY (FL-1/3/1)