| 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 |
|