REF

Payee Additional Identification

Pos: 120	Max: >1
Heading - Optional
Loop: 1000B	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification

M

ID

2/3

Required

Code

Name

0B

State License Number

1A

Blue Cross Provider Number

NOT ADVISED

1B

Blue Shield Provider Number

NOT ADVISED

1C

Medicare Provider Number

NOT ADVISED

1D

Medicaid Provider Number

NOT ADVISED

1E

Dentist License Number

NOT ADVISED

1F

Anesthesia License Number

NOT ADVISED

1G

Provider UPIN Number

1H

CHAMPUS Identification Number

NOT ADVISED

D3

National Association of Boards of Pharmacy Number

CODE SOURCE:

307: National Association of Boards of Pharmacy Number

G2

Provider Commercial Number

NOT ADVISED

N5

Provider Plan Network Identification Number

NOT ADVISED

PQ

Payee Identification

TJ

Federal Taxpayer's Identification Number

This information should be in the N1 segment unless the National Provider ID was used in N103/04. For individual providers as payees, use this number to represent the Social Security Number.

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Additional Payee Identifier

C

AN

1/30

Required

ExternalCodeList

Name: 307

Description: National Association of Boards of Pharmacy Number

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 REF segment only when more than one identification number is required to identify the payee. Always use the ID number available in the N1 segment before using the REF segment.

Example:

REF*PQ*12345678~