UB-04 (1628) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
9
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
40
LENGTH
3
SHORT DESCRIPTION
CONDITION CODE 3 (FL-20)
CALCULATE ONLY OR OUTPUT
OUTPUT
