UB-04 (1636) 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
64
LENGTH
3
SHORT DESCRIPTION
CONDITION CODE 11 (FL-28)
CALCULATE ONLY OR OUTPUT
OUTPUT
