REF

Information Receiver Additional Identification

Pos: 040	Max: 9
Detail - Optional
Loop: 2100B	Elements: 3

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
Use this code to specify or qualify the type of reference number that is following in REF02, REF03, or both.

M

ID

2/3

Required

Code

Name

0B

State License Number

The state assigning the license number must be identified in REF03.

1C

Medicare Provider Number

1D

Medicaid Provider Number

1J

Facility ID Number

4A

Personal Identification Number (PIN)

CT

Contract Number

EL

Electronic device pin number

EO

Submitter Identification Number

JD

User Identification

N5

Provider Plan Network Identification Number

N7

Facility Network Identification Number

Q4

Prior Identifier Number

SY

Social Security Number

The social security number may not be used for any Federally administered programs such as Medicare.

TJ

Federal Taxpayer's Identification Number

HPI

Health Care Financing Administration National Provider Identifier

The Health Care Financing Administration National Provider Identifier may be used in this segment prior to being mandated for use.

CODE SOURCE:

537: Health Care Financing Administration National Provider Identifier

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Information Receiver Additional Identifier
Use this information for the reference number as qualified by the preceding data element (REF01).

C

AN

1/30

Required

ExternalCodeList

Name: 537

Description: Health Care Financing Administration National Provider Identifier

REF03

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: License Number State Code
Use this element for the two character state code of the state assigning the identifier supplied in REF02. This element is required if the identifier supplied in REF02 is the State License Number. See Code source 22: States and Outlying Areas of the U.S.

C

AN

1/80

Situational

ExternalCodeList

Name: 22

Description: States and Outlying Areas of the U.S.

1.

R0203 - At least one of REF02,REF03 is required

1.

REF04 contains data relating to the value cited in REF02.

Notes:

1. Use this segment when needed to convey other or additional identification numbers for the information receiver. The type of reference number is determined by the qualifier in REF01.

Example:

REF*EO*477563928~