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Data Element Name:  Policy Number
Format-Length:  A/N - 19 Required For:  IP
Effective Date:  1/1/94 Revision Date:        

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2010BA NM108 66 MI Identification Code Qualifier
NM109 67 Member Identification Number

2010CA NM108 66 MI Identification Code Qualifier
NM109 67 Member Identification Number

2330A NM108 66 MI Identification Code Qualifier
NM109 67 Member Identification Number

Paper Form Locator Code Qualifier
Institutional - UB-04 60 N/A

Definition:

The unique identification number assigned by the payer associated with this sequence to identify the patient.

Codes and Values:

     1.     Payer      Type of Number
Blue Cross Enter information depending on plan information needs and specific contract requirements.

Commercial Insurers If a group, use insured ID number from claim form or ID card. If not available, use insured SSN. If an individual insurance contract is involved, use policy number.

Medicaid Enter Medicaid Identification number of the insured or case head Medicaid number shown on the Medicaid Identification card.

Medicare Enter the patient's Medicare HIC number as shown on the Health Insurance Card, Certificate of Award, Utilization Notice, Temporary Eligibility Notice, Hospital Transfer Form or as reported by the Social Security Office.

CHAMPUS Enter information depending on CHAMPUS regulations.

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

Edit Applications:

  1. Required if Claim Filing Indicator Code is Medicare (MA or MB), Medicaid (MC), Insurance Company (12, 16, CI, or HM), or Blue Cross (BL).
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