LEGACY UB-92 (712)    IB FORM SKELETON DEFINITION (364.6)

Name Value
BILL FORM LEGACY UB-92
SECURITY LEVEL NATIONAL,NO EDIT
PAGE OR SEQUENCE 1
FIRST LINE NUMBER 46
LOCAL OVERRIDE ALLOWED YES
STARTING COLUMN OR PIECE 57
LENGTH 11
SHORT DESCRIPTION DUE FRM PATIENT FL55 (FL-55/4)