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)