PER

Other Payer Contact Information

Pos: 345	Max: 2
Detail - Optional
Loop: 2330B	Elements: 8

Ref

Id

Element Name

Req

Type

Min/Max

Usage

PER01

366

Contact Function Code
Description: Code identifying the major duty or responsibility of the person or group named

M

ID

2/2

Required

Code

Name

IC

Information Contact

PER02

93

Name
Description: Free-form name
Industry: Other Payer Contact Name

O

AN

1/60

Required

PER03

365

Communication Number Qualifier
Description: Code identifying the type of communication number

C

ID

2/2

Required

Code

Name

ED

Electronic Data Interchange Access Number

EM

Electronic Mail

FX

Facsimile

TE

Telephone

PER04

364

Communication Number
Description: Complete communications number including country or area code when applicable

C

AN

1/80

Required

PER05

365

Communication Number Qualifier
Description: Code identifying the type of communication number
Used only when additional communications numbers need to be transmitted.

C

ID

2/2

Situational

Code

Name

ED

Electronic Data Interchange Access Number

EM

Electronic Mail

EX

Telephone Extension

FX

Facsimile

TE

Telephone

PER06

364

Communication Number
Description: Complete communications number including country or area code when applicable
Used only when additional communications numbers need to be transmitted.

C

AN

1/80

Situational

PER07

365

Communication Number Qualifier
Description: Code identifying the type of communication number
Used only when additional communications numbers need to be transmitted.

C

ID

2/2

Situational

Code

Name

ED

Electronic Data Interchange Access Number

EM

Electronic Mail

EX

Telephone Extension

FX

Facsimile

TE

Telephone

PER08

364

Communication Number
Description: Complete communications number including country or area code when applicable
Used only when additional communications numbers need to be transmitted.

C

AN

1/80

Situational

1.

P0304 - If either PER03,PER04 is present, then all are required

2.

P0506 - If either PER05,PER06 is present, then all are required

3.

P0708 - If either PER07,PER08 is present, then all are required

Notes:

1. This segment is used only in payer-to-payer COB situations. This segment may be completed by a payer who had adjudicated the claim and is passing it on to a secondary payer. It is not completed by submitting providers.
2. Each communication number should always include the area code. The extension when applicable, should be included in the appropriate PER element immediately after the telephone number (e.g., if the telephone number is included in PER03, then the extension should be in PER05).
3. When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number should always include the area code and phone number using the format AAABBBCCCC. Where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g. (534)224-2525 would be represented as 5342242525). The extension, when applicable, should be included in the communication number immediately after the telephone number.
4. By definition of the standard, if PER03 is used, PER04 is required.

Example:

PER*IC*SHELLY*TE*5552340000~