UB-04 (1561) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
3
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
26
LENGTH
25
SHORT DESCRIPTION
Pay-to Provider Address (FL-2/2)
