LEGACY UB-92 (760) 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
64
LOCAL OVERRIDE ALLOWED
YES
STARTING COLUMN OR PIECE
51
LENGTH
22
SHORT DESCRIPTION
PROVIDER REP LINE 1 (FL-85/1A)
