UB-04 (1672) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
58
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
10
LENGTH
6
SHORT DESCRIPTION
PRIN PROCEDURE DATE (FL-74/2)
