UB-04 (1634)    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 58
LENGTH 3
SHORT DESCRIPTION CONDITION CODE 9 (FL-26)
CALCULATE ONLY OR OUTPUT OUTPUT