UB-04 (1558) 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
13
LENGTH
10
SHORT DESCRIPTION
BILL PROVIDER FAX (FL-1/4/2)
