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Data Element Name:  Payer Identification Number
Format-Length:  A/N - 5 Required For:  AS, ED, IP
Effective Date:  1/1/94 Revision Date:  September 2003

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2010BC NM108 66 PI Payer ID Qualifier
NM109 67 Payer ID



REF01

128

2U/NF

Payer Secondary ID Qualifier
REF02 127 Payer Secondary ID

2330B NM108 66 PI Payer ID Qualifier
NM109 67 Payer ID


REF01

128

2U/NF

Payer Secondary ID Qualifier
REF02 127 Payer Secondary ID

Paper Form Locator Code Qualifier
Institutional - UB-04 51 N/A

Definition:

The number identifying the payer organization associated with this sequence for which the provider might expect some payment of the bill.

Codes and Values:

   1.   Payer Type of Number
Blue Cross Plan Number
Commercial Insurers NAIC or DOI Number
Medicaid State Agency Assigned number to be determined
Medicare Blue Cross Number or Commercial Insurer NAIC Number depending on intermediary
CHAMPUS NAIC Number

   2.   If this field is not applicable it must be blanks

Edit Applications:

  1. If Claim Filing Indicator Code is Insurance Company (12, 16, CI, or HM), then Payer Identification is required and must be reported. Commercial Insurance and HMO companies are regulated by the Department of Insurance (DOI) and issued either a NAIC or internal DOI numbers. Prepaid Health Service Plans (PHSP) are regulated by the Department of Health (DOH). In lieu of DOI numbers, DOH numbers are issued. Some billing situations require NEIC numbers to be reported. For additional information on these numbers, and specific HMO and PHSP codes, refer to Appendix K.

  2. If Claim Filing Indicator Code is Blue Cross (BL), then Payer Identification is required and must be a valid in accordance with the Blue Cross and Blue Shield Plan Numbers in Appendix L.
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