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| This is the service line level reference segment ID qualifier. |
| May contain organization-specific values: Yes |
| Category Entries: |
| Group or policy number |
| Member identification number |
| Repriced claim reference number |
| Adjusted repriced claim reference number |
| Employee identification number 4010 |
| Authorization number |
| Class of contract code |
| Medical record identification number |
| Original reference number |
| Prior authorization number |
| Predetermination of benefits identification number |
| Insurance policy number |
| Social security number |
| Blue cross provider number |
| Blue shield provider number |
| Medicare provider number |
| Medicaid provider number |
| Provider UPIN number |
| Tricare Identification Number |
| National association of boards of pharmacy number |
| Provider commercial number |
| Ambulatory patient group (APG) number |
| Provider control number |
| Attachment code |
| Location number |
| Rate code number |
| Facility ID number |
| Health care financing administration national provider identifier |
| Federal taxpayer's identification number |
| Employee Identification Number |
| Group Number |
| State Licence Number |
| Ambulatory Payment Classification |
| Policy Form Identifying Number |
| Supplemental Remittance Information |