# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | rx in position # | 0;1 | NUMERIC | B | The position within the transmission of the particular prescription that is being certified. | |
1 | ncpdp field # | 1;0 | MULTIPLE | 9002313.3121 | The NCPDP field that needs to be defaulted. | |
2 | sub clarification code mult | 2;0 | MULTIPLE | 9002313.3122 | This multiple will store the submission clarification codes, which will be used to populate the NCPDP field 420-DK. | |
3 | cob multiple | 3;0 | MULTIPLE | 9002313.3123 | This multiple structure stores information about each of the other payers involved in the payment or rejection of the claim. | |
4 | other amt claimed mult | 4;0 | MULTIPLE | 9002313.3124 | This multiple can contain up to three occurrences of less common charges. |
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