UB-04 (1704) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
19
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
.9
SHORT DESCRIPTION
REV CODE EXTRACT (FL-42:49)
CALCULATE ONLY OR OUTPUT
CALCULATE ONLY
