UB-04 (1614) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
55
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
18
LENGTH
7
SHORT DESCRIPTION
OTHER DIAG CODE 11(FL-67K/1/1)
