| 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 theUB Claimstab. The default for the Billing Provider references from Field Locator 51 on the UB claims from the Payers master file.
- Phys 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 Billing Provider references on 1500 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 Billing Provider and Rendering Provider references. The supervising physician's individual ID for Supervising Provider references.
- Tax ID– The rendering provider's tax ID for Billing Provider and Rendering Provider references. The supervising physician's tax ID for Supervising Provider references.
- State Lic Nbr– The state license number for Billing Provider, Referring Provider, and Rendering Provider references. The supervising physician's state license number for Supervising Provider references.
- Opt Clm Val 1– The optional claim value 1 from the Providers master file.
- Opt Clm Val 2– The optional claim value 2 from the Providers` master file.
- Submitter ID– The electronic submitter ID for the payer.
- Payer Opt Val– The practice/payer-specific value entered in thePractice Payer Opt Valfield on thePracticetab underPayermaster 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 Billing Provider and Rendering Provider references. The supervising physician's UPIN for Supervising Provider references.
- Group Opt Val– The Opt Group Val from the Group master file.
- Prov Loc Code– The Loc ID number from the Group Information section on the Practice tab of the provider master for Billing Provider and Rendering Provider references. This is a Medicaid clinic rate specific code for Supervising Provider references.
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