UB-04 (1642) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
43
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
39
LENGTH
2
SHORT DESCRIPTION
RELEASE OF INFO (FL-52A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
