UB-04 (1645) 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
54
LENGTH
11
SHORT DESCRIPTION
EST AMOUNT DUE (FL-55A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
