| Parent File | Name | Number | Package |
|---|---|---|---|
| BPS REQUESTS(#9002313.77) | COB OTHER PAYERS | 9002313.778 | E Claims Management Engine |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | OTHER PAYER COUNTER | 0;1 | NUMBER |
|
| .02 | OTHER PAYER COVERAGE TYPE | 0;2 | SET |
|
| .03 | OTHER PAYER ID QUALIFIER | 0;3 | SET |
|
| .04 | OTHER PAYER ID | 0;4 | FREE TEXT |
|
| .05 | OTHER PAYER DATE | 0;5 | DATE |
|
| .06 | OTHER PAYER AMOUNT PAID COUNT | 0;6 | NUMBER |
|
| .07 | OTHER PAYER REJECT COUNT | 0;7 | NUMBER |
|
| .11 | OTHER PAYER RECONCILIATION ID | 0;11 | FREE TEXT |
|
| 1 | OTHER PAYER AMT PAID MULTIPLE | 1;0 | Multiple #9002313.7781 | 9002313.7781
|
| 2 | OTHER PAYER REJECT MULTIPLE | 2;0 | Multiple #9002313.7782 | 9002313.7782
|