UB-04 (1619) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
14
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
44
LENGTH
3
SHORT DESCRIPTION
VALUE CODES CD 1 (FL-39a:d/1)
