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

N402 R Ordering ProviderState CodeN403 R Ordering ProviderPostal Zone or ZipCodeN404 S Ordering ProviderCountry CodeN405 N/A Location Qualifier Not UsedN406 N/A Location Identifier Not UsedRequired if the address is outsideof the U.S.Segment NameSegment IDLoop IDUsageSegment NotesElement UsageIDReferring Provider NameNM12420FSituationalGuideDescription/ValidValues93CommentsNM01 R Entity Identifier Code DN: Referring ProviderP3: Primary Care ProviderNM02 R Entity Type Qualifier 1: PersonNM03 R Referring ProviderLast NameNM04 R Referring ProviderFirst NameNM05 S Pr Referring ProviderMiddle NameNM06 N/A Name Prefix Not UsedNM07 S Referring ProviderName SuffixNM08 S 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 number