Files > COB MULTIPLE

parent

9002313.312

name

COB MULTIPLE

number

9002313.3123

Fields

#	Name	Location	Type	Details	Index	Description
.01	other payer counter	0;1	NUMERIC		B	This is a counter field to store the count of the other payers.
.02	other payer coverage type	0;2	SET OF CODES	01:PRIMARY 02:SECONDARY 03:TERTIARY		This stores the value for NCPDP field 338-5C, which is the code indicating whether the other payer is primary, secondary, etc.
.03	other payer id qualifier	0;3	SET OF CODES	01:NATIONAL PAYER ID 02:HEALTH INDUSTRY NUMBER (HIN) 03:BANK IDENTIFICATION NUMBER (BIN) 04:NAT. ASSOC. OF INS. COM. (NAIC) 05:MEDICARE CARRIER NUMBER 09:COUPON 99:OTHER		This value will be placed in the NCPDP field 339-6C, which is the code qualifying the 'Other Payer ID' (340-7C) field.
.04	other payer id	0;4	FREE TEXT			This will be used for the value in NCPDP field 340-7C, which is the ID assigned to the Other Payer.
.05	other payer date	0;5	DATE-TIME			This will be used for NCPDP field 443-E8, which is the payment or denial date of the claim submitted to the other payer.
.06	other payer amount paid count	0;6	NUMERIC			This will be used for NCPDP field 341-HB, which is the count of the Other Payer Paid Amount occurrences.
.07	other payer reject count	0;7	NUMERIC			This is used for NCPDP field 471-5E, which is the count of Other Payer Reject Code occurrences.
1	other payer amt paid multiple	1;0	MULTIPLE	9002313.31231		This multiple can contain up to 9 occurrences of paid amounts from the other payer.
2	other payer reject multiple	2;0	MULTIPLE	9002313.31232		This multiple will store the reject codes returned by the other payer. There can be up to 20 occurrences per the NCPDP documentation.
3	other payer patient resp mult	3;0	MULTIPLE	9002313.31233		This multiple holds the paid amounts that are the responsibility of the patient from a previous payer.
4	benefit stage mult	4;0	MULTIPLE	9002313.31234		This multiple can contain up to four occurrences of Medicare Part D beneficiary benefit stages.