UB-04 (1666) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
51
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
1
LENGTH
31
SHORT DESCRIPTION
TREATMNT AUTH CODES (FL-63A:C)
CALCULATE ONLY OR OUTPUT
OUTPUT
