United States Health Information Knowledgebase


Other Amount Claimed Submitted

Name:Other Amount Claimed Submitted
Definition:Amount representing the additional incurred costs for a dispensed prescription or service.
Type:Data Element
Representation Format:s$$$$$$cc
Example:Comments: Qualified by 'Other Amount Claimed Submitted Qualifier' (479-H8).
Examples: If the other amount claimed submitted is $12.55, this field would reflect: 125E.
Registration Authority:National Council for Prescription Drug Programs
Source:National Council for Prescription Drug Programs
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