UB-04 (1555) 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
14
LENGTH
2
SHORT DESCRIPTION
BILL PROVIDER STATE (FL-1/3/2)
