UB-04 (1613) 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
MAX NUMBER LINES
5
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
1
LENGTH
42
SHORT DESCRIPTION
CURR PAYER NAME/ADDR (FL-38)
