UB-04 (1622) 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
60
LENGTH
10
SHORT DESCRIPTION
VALUE CODES AMT 2 (FL-40a:d/2)
