| |
|
|
|
|
|
|
|
|
|
|
| |
_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
|
|
| |
REF01 |
128 |
Reference Identification Qualifier |
M |
ID |
2/3 |
|
|
| |
|
|
Description: Code qualifying the Reference Identification |
| |
|
|
|
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 |
| |
|
|
|
1F |
Anesthesia License Number |
| |
|
|
|
1G |
Provider UPIN Number |
| |
|
|
|
1H |
CHAMPUS Identification Number |
| |
|
|
|
D3 |
National Association of Boards of Pharmacy Number |
| |
|
|
|
G2 |
Provider Commercial Number |
| |
|
|
|
|
Description: A unique number assigned to a provider by a commercial insurer |
| |
|
|
|
N5 |
Provider Plan Network Identification Number |
| |
|
|
|
|
Description: A number assigned to identify a specific provider in a health care plan network |
| |
|
|
|
PQ |
Payee Identification |
| |
|
|
|
TJ |
Federal Taxpayer's Identification Number |
| |
REF02 |
127 |
Reference Identification |
C |
AN |
1/30 |
|
|
| |
|
|
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier |
