UB-04 (1661) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
47
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
1
LENGTH
26
SHORT DESCRIPTION
INSUREDS NAME (FL-58A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
