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

U.S.N405 N/A Location Qualifier Not UsedN406 N/A Location Identifier Not UsedSegment NameSegment IDLoop IDUsageSegment NotesElement UsageIDBilling Provider Secondary InformationREF2010AARequiredGuideDescription/ValidValuesREF01 R Reference IdentifierQualifierREF02 R Billing ProviderAdditional IdentifierREF03 N/A Description Not UsedREF04 N/A Reference Identifier Not UsedComments1D = Provider Medicaid NumberG2 = Provider Commercial NumberEI = Employer Identification numberMedicaid numbers can be a minimum of9 positions up to 11 positions in lengthSegment NameSegment IDLoop IDUsageSegment NotesElement UsageIDBilling Provider Contact InformationPER2010AARequiredGuideDescription/ValidValuesPER01 RContact FunctionCodePER02 R Billing ProviderContact NamePER03 R CommunicationNumber QualifierPER04 R CommunicationNumber43CommentsIC: Information ContactEM: Electronic MailFX: FacsimileTE: Telephone