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Magellan Behavioral Health 837 Professional Companion GuideREFElement Summary:Payer Secondary IdentificationPos: 035 Max: 3Detail - OptionalLoop:Elements: 22010BBRef Id Element Name Req Type Min/Max UsageREF01 128 Reference Identification QualifierM ID 2/3 RequiredDescription: Code qualifying the ReferenceIdentificationMagellan Specific Note: This value is either 'NF'(for NAIC number) or 'FY' (for PO Box number forinternal routing.) If PO box number is sent in thissegment, Magellan should receive two REFsegments. This segment is the preferredsubmittal location for PO Box number (as aClaim Office Number).REF02 127 Reference IdentificationC AN 1/30 RequiredDescription: Reference information as defined for aparticular Transaction Set or as specified by theReference Identification QualifierMagellan Specific Note: This field is used tostore Magellan's NAIC number (with a leadingzero) or an additional PO BOX number. Pleasepopulate with a value of '01260' for theIdentification number or populate with the POBOX value for an additional PO BOX. RadiologyNIA claims go to ‘1428’._________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 17
Magellan Behavioral Health 837 Professional Companion GuideCLMElement Summary:Claim InformationPos: 130 Max: 1Detail - OptionalLoop: 2300 Elements: 1Ref Id Element Name Req Type Min/Max UsageCLM05 C023 Health Care Service Location InformationO Comp RequiredCLM05-3 1325Description: To provide information that identifiesthe place of service or the type of bill related to thelocation at which a health care service was renderedClaim Frequency Type CodeDescription: Code specifying the frequency of theclaim; this is the third position of the Uniform BillingClaim Form Bill TypeMagellan Specific Note: Claims with a value of'7' or '8' may result in a duplicate claim rejection.O ID 1/1 Required_________________________________________________________________________________________________________________________Revised: February 14, 2008 HIPAA X12 837p (004010X098A1) Version 7 18
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