UB-04 (1686) 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
33
LENGTH
1
SHORT DESCRIPTION
OTHER DIAG 3 POA (FL-67C/1/2)
