UB-04 (1739) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
64
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
71
LENGTH
12
SHORT DESCRIPTION
OTHER NAME (FL-79/2/2)
