UB-04 (1753) IB FORM SKELETON DEFINITION (364.6)
Name
Value
BILL FORM
UB-04
SECURITY LEVEL
NATIONAL,NO EDIT
PAGE OR SEQUENCE
1
FIRST LINE NUMBER
63
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
74
LENGTH
9
SHORT DESCRIPTION
OTHER PROV ID (FL-79/1/4)
