UB-04 (1650) 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
42
LENGTH
7
SHORT DESCRIPTION
OTHER DIAG CODE 5 (FL-67E/1/1)
