REF

Rendering Provider Secondary Identification

Pos: 271	Max: 5
Detail - Optional
Loop: 2310B	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
NSF Reference: FA0-57.0

M

ID

2/3

Required

Code

Name

0B

State License Number

1B

Blue Shield Provider Number

1C

Medicare Provider Number

1D

Medicaid Provider Number

1G

Provider UPIN Number

1H

CHAMPUS Identification Number

EI

Employer's Identification Number

G2

Provider Commercial Number

LU

Location Number

N5

Provider Plan Network Identification 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: Rendering Provider Secondary Identifier
NSF Reference: FA0-58.0

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 NM109 in this loop.

Example:

REF*1D*A12345~