LEGACY UB-92 (761) 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
73
LENGTH
8
SHORT DESCRIPTION
PROVIDER REP DATE (FL-85/1B)
