UB-04 (1690) 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
65
LENGTH
1
SHORT DESCRIPTION
OTHER DIAG 7 POA (FL-67G/1/2)
