837P Companion Guide - Peach State Health Plan Peach State ...

PRV02 R ReferenceIdentification QualifierPRV03 R ReferenceIdentificationPT = Pay toZZProvider Taxonomy CodeSegment Name Provider Billing NameSegment ID NM1Loop ID 2010 Repeat: 10UsageRequiredSegment NotesElement Usage GuideCommentsIDDescription/ValidValuesNM101 R Entity Identifier Code 85: Billing ProviderUse this code to indicate billingprovider, billing submitter, andencounter reporting entity.NM102 R Entity Type Qualifier 1: Person2: Non-person EntityNM103 R Billing Provider Last orOrganizational NameNM104 S Name FirstNM105 S Name Middle Not UsedNM106 N/A Name Prefix Not UsedNM107 S Name Suffix Not UsedNM108 R Identification CodeQualifierIf “XX” is used, then either theEmployer’s Identification numberor the Social Security Number ofthe provider must be carried in theREF segment, in this loop.24: Employer IdentificationNumber34: Social Security numberXX: HCFA National ProviderIdentifier41Note: After NPI implementation, if the