AMT

Coordination of Benefits (COB) Total Submitted Charges

Pos: 300	Max: 1
Detail - Optional
Loop: 2320	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AMT01

522

Amount Qualifier Code
Description: Code to qualify amount

M

ID

1/3

Required

Code

Name

T3

Total Submitted Charges

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Coordination of Benefits Total Submitted Charge Amount
EMC v.6.0 Reference: Record Type 92 Field No. 6 (For COB use. Use this amount for the total claim level submitted charges.)

M

R

1/18

Required

Notes:

1. This segment is for COB use.
2. This segment is used to convey the COB Total Submitted Charges applicable to this claim when known.

Example:

AMT*T3*7490.7~