| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | other amount claimed submitted | 0;1 | NUMERIC | B | This will be used for NCPDP field 480-H9 (Other Claim Amount Submitted), which holds the dollar amount that represents the additional incurred costs for a dispensed prescription. | |
| .02 | other amount claimed qualifier | 0;2 | SET OF CODES | 01:DELIVERY COST 02:SHIPPING COST 03:POSTAGE COST 04:ADMINISTRATIVE COST 09:COMPOUND PREP COST SUBMITTED 99:OTHER | This will be used for NCPDP field 479-H8 (Other Amount Claimed Submitted Qualifier), which is used to describe the dollar amount in the 480-H9 field. |
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