| Parent File | Name | Number | Package |
|---|---|---|---|
| 9002313.0201 | COB/Other Payments | 9002313.0401 | Pharmacy Point of Sale |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | COB/Other Paymnt Cntr | 0;1 | FREE TEXT |
|
| 338 | Other Payer Coverage Type | 0;2 | FREE TEXT |
|
| 339 | Other Payer ID Qualifier | 0;3 | FREE TEXT |
|
| 340 | Other Payer ID | 0;4 | FREE TEXT |
|
| 341 | Other Payer Amt Paid Cnt | 0;6 | FREE TEXT |
|
| 342 | Other Payer Amt Paid Qual | 1;0 | Multiple #9002313.401342 | 9002313.401342 |
| 443 | Other Payer Date | 0;5 | FREE TEXT |
|
| 471 | Other Payer Reject Count | 0;7 | FREE TEXT |
|
| 472 | Other Payer Reject Code | 2;0 | Multiple #9002313.401472 | 9002313.401472 |