UB-04 (1749) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
19
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
70
LENGTH
10
SHORT DESCRIPTION
NON-COVERED CHARGES (FL-48)
