UB-04 (1708)    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 24
LENGTH 7
SHORT DESCRIPTION PATIENT REASON DX (FL-70/1/2)