UB-04 (1624) 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
73
LENGTH
10
SHORT DESCRIPTION
VALUE CODES AMT 3 (FL-41a:d/2)
