UB-04 (1724) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
2
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
26
SHORT DESCRIPTION
GATHER PAY-TO PROVIDER DATA FOR FL-2
CALCULATE ONLY OR OUTPUT
CALCULATE ONLY
