1000B N103 ID Code Qualifier - Federal “FI” Taxpayer ID number 1000B N104 Identification Premium Payer ID Code 2000B INDIVIDUAL REMITTANCE ENT=Individual Remittance Sample: ENT*1*2J*34*123456789~ 2000B Assigned Number Sequential Number assigned for differentiation within a transaction set 2000B Entity Identifier - Individual “2J” Code 2000B Identification - Social Security “34” Code Qualifier Number 2000B Identification Individual Identifier - Code SSN 2100B INDIVIDUAL NAME NM1=Policyholder Name Sample: NM1*QE*1*DOE*JOHN*Q***N*1234567890123~ 2100B Entity Identifier - Policyholder “QE” Code (Recipient Name) 2100B Policyholder - Person “1” 2100B Name Last Individual Last Name 2100B Name First Individual First Name 2100B Name Middle Individual Middle Initial 2100B NOT USED NOT USED 2100B NOT USED NOT USED
1000B N103 ID Code Qualifier “FI” - Federal Taxpayer ID number 1000B N104 Identification Code Premium Payer ID 2000B INDIVIDUAL REMITTANCE ENT=Individual Remittance Sample: ENT*1*2J*34*123456789~ 2000B Assigned Number Sequential Number assigned for differentiation within a transaction set 2000B Entity Identifier Code “2J” - Individual 2000B Identification Code Qualifier “34” - Social Security Number 2000B Identification Code Individual Identifier - SSN 2100B INDIVIDUAL NAME NM1=Policyholder Name Sample: NM1*QE*1*DOE*JOHN*Q***N*1234567890123~ 2100B Entity Identifier Code “QE” - Policyholder (Recipient Name) 2100B Policyholder “1” - Person 2100B Name Last Individual Last Name 2100B Name First Individual First Name 2100B Name Middle Individual Middle Initial 2100B NOT USED NOT USED 2100B NOT USED NOT USED
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx