Box 17a - Other ID#

What is it?

Box 17a is the non-NPI ID of the referring provider and is a unique identifier or a taxonomy code. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a. The available qualifiers are:

• 9F - Medicaid Montana Passport
• 0B - State License Number
• G2 - Provider Commercial Number

In Application:

To manually change this information:

1. Navigate to Providers > Referring Providers.
2. Edit the desired provider using the icon.
3. Enter the ID into the Box 17a and select the corresponding qualifier using the drop-down.
4. Select Save & Done.

EDI File

9F Qualifier

• Loop 2300, Segment REF02

0B and G2 Qualifiers

• Loop 2310A, Segment REF02