	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	PRV01	1221	Provider Code Description: Code identifying the type of provider	M	ID	1/3	Required

	Code	Name
	H	Hospital
	R	Rural Health Clinic
	AD	Admitting
	AT	Attending
	BI	Billing
	CO	Consulting
	CV	Covering
	HH	Home Health Care
	LA	Laboratory
	OT	Other Physician
	P1	Pharmacist
	P2	Pharmacy
	PC	Primary Care Physician
	PE	Performing
	RF	Referring
	SB	Submitting
	SK	Skilled Nursing Facility
	SU	Supervising

PRV02

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
If the National Provider ID is mandated for use, code value “HPI” must be used, otherwise one of the other code values may be used.
ZZ is used to indicate the “Health Care Provider Taxonomy” code list (provider specialty code) which is available on the Washington Publishing Company web site: http://www.wpc-edi.com. This taxonomy is maintained by the Blue Cross Blue Shield Association and ASC X12N TG2 WG15.

2/3

Required

Code

Name

Servicer

Use this code for the identification number assigned by the information source to be used by the information receiver in health care transactions.

National Association of Boards of Pharmacy Number

CODE SOURCE:

307: National Association of Boards of Pharmacy Number

Employer's Identification Number

Social Security Number

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

Federal Taxpayer's Identification Number

Mutually Defined

Health Care Provider Taxonomy Code list.

HPI

Health Care Financing Administration National Provider Identifier

Required value when identifying a specific provider when the National Provider ID is mandated for use. Otherwise, one of the other listed codes may be used.

CODE SOURCE:

537: Health Care Financing Administration National Provider Identifier

PRV03

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Provider Identifier
Use this reference number as qualified by the preceding data element (PRV02).

1/30

Required

Notes:

1. Use this segment when needed to either identify a specific provider or associate a specialty type related to the service identified in the 2110C loop.
2. If identifying a specific provider, use this segment to convey specific information about a provider’s role in the eligibility/benefit being inquired about when the provider is not the information receiver. For example, if the information receiver is a hospital and a referring provider must be identified, this is the segment where the referring provider would be identified.
3. If identifying a specific provider, this segment contains reference identification numbers, all of which may be used up until the time the National Provider Identifier (NPI) is mandated for use. After the NPI is mandated, only the code for National Provider Identifier may be used.
4. If identifying a type of specialty associated with the services identified in loop 2110C, use code ZZ in PRV02 and the appropriate code in PRV03.
5. PRV02 qualifies PRV03.

Example:

PRV*PE*EI*9991234567~
PRV*PE*ZZ*203BA0504N~

	ExternalCodeList
	Name: 307
	Description: National Association of Boards of Pharmacy Number

	ExternalCodeList
	Name: 537
	Description: Health Care Financing Administration National Provider Identifier

	ExternalCodeList
	Name: HCPT
	Description: Health Care Provider Taxonomy