Payer ID provider number reference — Facility
Payer ID provider number reference — Facility Rev. January 2022 2 Payer information Prefix Product name for electronic claims Emdeon payer information* Paper claim mailing address Billing provider ISA-08 GS-03 Personal Choice® (continued) Independence Valid and registered NPIReserve, is required. Electronic (837I) Loop 2010AA NM108 = XX
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