| Qualifier | Select the Reference Qualifier, according to the payer, to use in REF01 of the 837 electronic file. |
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| Data Element |
- Select the provider ID Data Type to use in REF02 of the 837 electronic file. Options for this field include the following:
- FL51 - (This option only displays on the UB Claims tab.) The default for the 2010A Billing Provider references from Field Locator 51 on the UB claims from the payer master.
- Physician Billing ID - If the provider is attached to a billing group, the Physician Billing ID is the group number. If not, then it is the individual provider number. The Physician Billing ID is the default for the 2010A Billing Provider references on HCFA claims.
- Group Nbr - The group number for the rendering physician. If the rendering physician is not attached to a group, the field will be blank.
- Indiv Phys ID - The individual provider number for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's individual ID for 2310E Supervising Provider references.
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- Tax ID - The rendering provider's tax ID for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's tax ID for 2310E Supervising Provider references.
- State Lic Nbr - The state license number for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's state license number for 2310E Supervising Provider references.
- Opt Clm Val 1 - The optional claim value 1 from the provider master file.
- Opt Clm Val 2 - The optional claim value 2 from the provider master file.
- Submitter ID - The electronic submitter ID for the payer.
- Payer Opt Val - The practice/payer-specific value entered in the Practice Payer Opt Val field on the Practice Parameters tab of the payer master file.
- Phys Site ID - The default payer from the provider/location setup.
- Loc Site ID - The location master site ID.
- Facility ID - The facility ID, if available, from the Location master file. It can be any one of the three Claim Type Specific Codes: Medicare Facility ID, BCBS Facility ID, and Medicaid Facility ID.
- UPIN - The rendering provider's UPIN for 2010A Billing Provider and 2310B Rendering Provider references. The supervising physician's UPIN for 2310E Supervising Provider references.
- Group Opt Val - The Opt Group Val from the group master.
- Prov Loc Code - The Loc ID number from the Group Information section on the Practice tab of the provider master for 2010A Billing Provider and 2310B Rendering Provider references. This is a Medicaid clinic rate specific code for 2310E Supervising Provider references.
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