Paper Claim - Pds Input
EXHIBIT BREQUIRED FIELDS FOR PRE-DELIVERY SERVICE CLAIM
Dealer Number Claim Number VIN (Vehicle Identification Number) DOFU (Date of First Use)
- Should always be 00-00-00, by definition
- Cannot be BLANK
Repair Order Number
Repair Date:
Miles:
- Must be greater than zero Operation Code:
- Must always be "001013" Labor Hours:
- From Flat Rate Master File Total Labor Amount:
- Must equal "Total Claim Amount" Total Claim Amount
- Must equal "Total Labor Amount"
- No parts or sublet amounts are allowed
CONDITIONAL FIELDS
DSM Authorization Number and Type:
Required for claim submission beyond 30 days from repair