UB-04 (1557)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 5
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 1
LENGTH 10
SHORT DESCRIPTION BILL PROVIDER PHONE (FL-1/4/1)