UB-04 (1747) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
61
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
72
LENGTH
2
SHORT DESCRIPTION
OTHER PROV ID QUAL (FL-78/1/3)
