UB-04 (1643) 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
42
LENGTH
2
SHORT DESCRIPTION
ASSIGN OF BENEFITS (FL-53A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
