UB-04 (1648) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
54
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
26
LENGTH
7
SHORT DESCRIPTION
OTHER DIAG CODE 3 (FL-67C/1/1)
