837P Companion Guide - Peach State Health Plan Peach State ...
837P Companion Guide - Peach State Health Plan Peach State ...
837P Companion Guide - Peach State Health Plan Peach State ...
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Middle NameNM106 N/A Name Prefix Not UsedNM107 S Rendering ProviderName SuffixNM108 R Identification CodeQualifierNM109 R Rendering ProviderIdentifierNM110 N/A Entity RelationshipCodeNM111 N/A Entity Identifier Code Not UsedIf “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 ProviderIdentifierNote: After NPI implementation, if theprovider is required to obtain an NPI,you must submit NPI as the identifierin this element.If NM108 = 24, then give provider TIN,IRS number.If NM108 = 34, then give provider SS NIf NM108 = XX, then give provider NPINot UsedSegment NameSegment IDLoop IDUsageSegment NotesElement UsageIDRendering Provider Secondary InformationPRV2420ASituational<strong>Guide</strong>Description/ValidValuesPRV01 R Provider Code PECommentsPRV02 R ReferenceIdentification QualifierZZ88