| Parent File | Name | Number | Package | 
|---|---|---|---|
| 9002313.0301 | OTHER AMOUNTS PAID | 9002313.1401 | E Claims Management Engine | 
| Field # | Name | Loc | Type | Details | 
|---|---|---|---|---|
| .01 | OTHER AMOUNT PAID COUNTER | 0;1 | NUMBER | 
  | 
| 564 | OTHER AMOUNT PAID QUALIFIER | 1;1 | FREE TEXT | 
  | 
| 565 | OTHER AMOUNT PAID | 1;2 | FREE TEXT | 
  |