REF

Billing Provider Secondary Identification

Pos: 035	Max: 8
Detail - Optional
Loop: 2010AA	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
Codes 8U, LU, ST, TT, 06, IJ, RB, and EM were added to this implementation guide to support credit/debit card information billing. See Appendix G, Credit/Debit Card Use, for details.

M

ID

2/3

Required

Code

Name

0B

State License Number

1A

Blue Cross Provider Number

UB-92 Ref. [UB-Name]:

51 (A-C) [Provider Number]

EMC v.6.0 Reference:

Record Type 10 Field No. 9, 10 Record Type 30 Field No. 24

1B

Blue Shield Provider Number

1C

Medicare Provider Number

UB-92 Ref. [UB-Name]:

51 (A-C) [Provider Number]

EMC v.6.0 Reference:

Record Type 10 Field No. 6 Record Type 30 Field No. 24

1D

Medicaid Provider Number

UB-92 Ref. [UB-Name]:

51 (A-C) [Provider Number]

EMC v.6.0 Reference:

Record Type 10 Field No. 7

1G

Provider UPIN Number

1H

CHAMPUS Identification Number

UB-92 Ref. [UB-Name]:

51 (A-C) [Provider Number]

EMC v.6.0 Reference:

Record Type 10 Field No. 8 Record Type 30 Field No. 24

1J

Facility ID Number

B3

Preferred Provider Organization Number

BQ

Health Maintenance Organization Code Number

Description: A unique number assigned to each individual Health Maintenance Organization (HMO) health insurance plan (assigned by the HMO)

EI

Employer's Identification Number

UB-92 Ref. [UB-Name]:

5 [Payer Identification]

EMC v.6.0 Reference:

Record Type 10 Field No. 4, 5

FH

Clinic Number

Description: A unique number identifying the clinic location that rendered services

G2

Provider Commercial Number

Description: A unique number assigned to a provider by a commercial insurer

UB-92 Ref. [UB-Name]:

51 (A-C) [Provider Number]

EMC v.6.0 Reference:

Record Type 10 Field No. 9, 10 Record Type 30 Field No. 24

G5

Provider Site Number

LU

Location Number

SY

Social Security Number

The social security number may not be used for Medicare.

UB-92 Ref. [UB-Name]:

5 [Payer Identification]

EMC v.6.0 Reference:

Record Type 10 Field No. 4, 5

X5

State Industrial Accident Provider Number

REF02

127

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

C

AN

1/30

Required

1.

R0203 - At least one of REF02,REF03 is required

1.

REF04 contains data relating to the value cited in REF02.

Notes:

1. Required when a secondary identification number is necessary to identify the entity. The primary identification number should be carried in NM109.
2. If the reason the number is being used in this REF can be met by the NPI, carried in the NM108/09 of this loop, then this REF is not used.
3. If “code XX - NPI” is used in the NM108/09 of this loop, then either the Employer’s Identification Number or the Social Security Number of the provider must be carried in this REF. The number sent is the one which is used on the 1099. If additional numbers are needed the REF can be run up to 8 times.

Example:

REF*SY*987654~