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Web2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Ø1-NPI M 2Ø1-B1 SERVICE PROVIDER ID M 4Ø1-D1 DATE OF SERVICE M CCYYMMDD 11Ø-AK SOFTWARE VENDOR/CERTIFICATION ID M Use value for Switch’s requirements Insurance Segment Questions Check Claim Billing/Claim Rebill If Situational, Payer Situation This Segment is always sent X WebPRIME HEALTH SERVICES, INC. PRIME AUTO PH-4 PAYOR PLAN SUMMARY Contracted Organization Prime Health Services, Inc. Product Auto Liability plans Service Area Idaho, Utah Service Effective Date 02/18/11 Contracted Network NMG Chiropractic Network COMPENSATION TERMS AND CONDITIONS asuka class
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