UB-04 (1615) 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
26
LENGTH
7
SHORT DESCRIPTION
OTHER DIAG CODE 12(FL-67L/1/1)
