Understanding ID Qualifiers in Healthcare Claims
An ID qualifier is a two-character code used on healthcare claim forms to identify the type of secondary identifier being reported when a National Provider Identifier (NPI) is not used or when additional identifiers are required. These qualifiers ensure that payers can accurately interpret non‑NPI identifiers—such as state license numbers or payer‑assigned provider IDs—thus preventing processing errors and denials.
Source: DaisyBill Knowledge Base
ID Qualifier on the CMS‑1500 Claim Form
The CMS‑1500 claim form (also known as HCFA 1500) uses ID qualifiers in specific fields to report non‑NPI provider identifiers. These qualifiers appear in:
- Box 17a (Referring/Ordering/Supervising Provider)
- Box 24I (Rendering Provider)
- Box 33b (Billing Provider Secondary ID)
Source: NUCC 1500 Health Insurance Claim Form Instruction Manual (v11.0)
Common CMS‑1500 ID Qualifiers
- 0B – State license number
- 1B – Blue Shield provider number
- 1C – Medicare provider number
- 1D – Medicaid provider number
- 1G – Provider UPIN number
- 1H – CHAMPUS identification number
- EI – Employer’s identification number
- G2 – Provider commercial number
- LU – Location number
- N5 – Provider plan network identification number
- SY – Social Security number (not for Medicare)
- X5 – State industrial accident provider number
- ZZ – Provider taxonomy code (10‑character taxonomy list)
Source: NUCC 1500 Health Insurance Claim Form Instruction Manual (v11.0)
ID Qualifier on the UB‑04 Claim Form
The UB‑04 claim form (CMS‑1450) is used by institutional providers and also employs ID qualifiers to report provider taxonomy and secondary identifiers. Key form locators include:
- Locator 76 – Attending Provider ID
- Locator 77 – Operating Provider ID
- Locator 78–79 – Other Provider IDs
- Locator 81 – Taxonomy‑Code Field
Source: ForwardHealth Update (2012‑28)
Common UB‑04 ID Qualifiers
- B3 – Health Care Provider Taxonomy Code, used in Locator 81 to report the 10‑digit taxonomy code
- DN – Referring Provider, used in Locator 78 to indicate a referring provider’s secondary ID
- ZZ – Other Operating Physician, used in Locator 78–79 to indicate an other operating physician’s secondary ID
Source: CMS Medicare Claims Processing Manual Chapter 25
Examples of Completing ID Qualifier Fields
- CMS‑1500 (Box 17a): To report a state license number for a referring provider, enter “0B” in the qualifier field of Box 17a and then input the license number in the shaded box.
- UB‑04 (Locator 81): To report your provider taxonomy, enter “B3” in the qualifier of Locator 81 and follow it with your 10‑character taxonomy code.
Best Practices
- Match qualifier to identifier: Always select the qualifier that exactly corresponds to the identifier you are reporting to avoid claim rejections.
- Maintain up-to-date software: Ensure your billing software supports the current CMS‑1500 (02/12) and UB‑04 specifications and includes all relevant qualifiers.
Conclusion
Correct application of ID qualifiers on both the CMS‑1500 and UB‑04 claim forms is essential for clear communication of provider identifiers and efficient claims processing. By familiarizing yourself with qualifiers such as 0B, 1B, 1C, 1D, and ZZ on the CMS‑1500, and B3, DN, and ZZ on the UB‑04, you can significantly reduce errors and streamline reimbursement.