UB-04 (1699) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
55
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
65
LENGTH
1
SHORT DESCRIPTION
OTHER DIAG 16 POA (FL-67P/1/2)
