REF

Pay-to Provider Secondary Identification Number

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

1E

Dentist License Number

1H

CHAMPUS Identification Number

EI

Employer's Identification Number

G2

Provider Commercial Number

G5

Provider Site Number

LU

Location Number

SY

Social Security Number

The Social Security Number may not be used for Medicare.

TJ

Federal Taxpayer's Identification 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 Identifier
NSF Reference: BA0-02.0, BA0-06.0, BA0-09.0, BA0-10.0, BA0-13.0, BA0-14.0, BA0-15. 0, BA0-16.0, BA0-17.0, BA0-24.0, BA0-25.0, BA1-02.0, CA0-28.0, YA0-02.0, YA0-06.0

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 the NM108/109 of this loop.
2. If the reason the number is being used in this REF can be met by the NPI, carried in the NM108/NM109 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, Social Security Number or Federal Tax Identification Number of the Provider must be carried in this REF. The number sent is the one which is used in the 1099. If additional numbers are needed in the REF it can be run up to 5 times.

Example:

REF*SY*111222333~