UB-04 (1707) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
56
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
17
LENGTH
7
SHORT DESCRIPTION
PATIENT REASON DX (FL-70/1/1)
