UB-04 (1612)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM UB-04
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 13
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE .7
SHORT DESCRIPTION CURRENT PAYER ADDRESS EXTRACT
CALCULATE ONLY OR OUTPUT CALCULATE ONLY