REF

Pay-To Provider Secondary Identification

Pos: 035	Max: 5
Detail - Optional
Loop: 2010AB	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

1B

Blue Shield Provider Number

1C

Medicare Provider Number

1D

Medicaid Provider Number

1G

Provider UPIN Number

1H

CHAMPUS Identification Number

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

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

G5

Provider Site Number

LU

Location Number

SY

Social Security Number

The social security number may not be used for Medicare.

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: Pay-to 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 “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 5 times.

Example:

REF*1G*98765~