UB-04 (1563) 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
43
LENGTH
2
SHORT DESCRIPTION
Pay-to Provider State (FL-2/3/2)
