UB-04 (1652) 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
58
LENGTH
7
SHORT DESCRIPTION
OTHER DIAG CODE 7 (FL-67G/1/1)
