UB-04 (1608) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
9
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
25
LENGTH
1
SHORT DESCRIPTION
ADMISSION SOURCE (FL-15)
CALCULATE ONLY OR OUTPUT
OUTPUT
