Sub-Field: 9002313.0601

Parent File	Name	Number	Package
9002313.0201	OTHER AMT CLAIMED MULTIPLE	9002313.0601	E Claims Management Engine

Details

Field # Name Loc Type Details

Field #	Name	Loc	Type	Details
.01	OTHER AMT CLAIMED COUNTER	0;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>2!($L(X)<1) X` LAST EDITED: `OCT 13, 2010` HELP-PROMPT: `Answer must be 1-2 characters.` DESCRIPTION: `This is the number of other claimed amount entries in the sub-file. It is used for coordination of benefits.` TECHNICAL DESCR: `Sequential counter of Other Amount Claimed occurrences.` CROSS-REFERENCE: `9002313.0601^B` `1)= S ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)=""` `2)= K ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)`
479	OTHER AMT CLAIMED SUBM QLFR	0;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<4) X` LAST EDITED: `MAR 30, 2021` HELP-PROMPT: `Answer must be 4 characters in length.` DESCRIPTION: `This is the code identifying the additional incurred cost claimed in Other Amount Claimed Submitted (480-H9). It is NCPDP field 479-H8.` TECHNICAL DESCR: `REQUEST PRICING SEGMENT.`
480	OTHER AMT CLAIMED SUBMITTED	0;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` LAST EDITED: `MAR 30, 2021` HELP-PROMPT: `Answer must be 10 characters in length.` DESCRIPTION: `This is the amount representing the additional incurred costs for a dispensed prescription or service. It is NCPDP field 480-H9.` TECHNICAL DESCR: `Format=s$$$$$$cc` `Qualified by Other Amount Claimed Submitted Qualifier (479-H8).` `Examples: If the other amount claimed submitted is $12.55, this field would reflect: 125E.` `REQUEST PRICING SEGMENT.`

OTHER AMT CLAIMED COUNTER

0;1

FREE TEXT

INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: OCT 13, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION:
This is the number of other claimed amount entries in the sub-file. It is used for coordination of benefits.
TECHNICAL DESCR:
Sequential counter of Other Amount Claimed occurrences.
CROSS-REFERENCE: 9002313.0601^B
1)= S ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)

OTHER AMT CLAIMED SUBM QLFR

0;2

FREE TEXT

INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length.
DESCRIPTION:
This is the code identifying the additional incurred cost claimed in Other Amount Claimed Submitted (480-H9). It is NCPDP field 479-H8.
TECHNICAL DESCR:
REQUEST PRICING SEGMENT.

OTHER AMT CLAIMED SUBMITTED

0;3

FREE TEXT

INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION:
This is the amount representing the additional incurred costs for a dispensed prescription or service. It is NCPDP field 480-H9.
TECHNICAL DESCR: Format=s$$$$$$cc
Qualified by Other Amount Claimed Submitted Qualifier (479-H8).
Examples: If the other amount claimed submitted is $12.55, this field would reflect: 125E.
REQUEST PRICING SEGMENT.