|Name:||Other Amount Claimed Submitted|
|Definition:||Amount representing the additional incurred costs for a dispensed prescription or service.|
|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|