REF

Subscriber Additional Information

Pos: 190	Max: 1
Detail - Optional
Loop: 2110C	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification
Use this code to specify or qualify the type of reference number that is following in REF02, REF03, or both.

M

ID

2/3

Required

Code

Name

9F

Referral Number

G1

Prior Authorization Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Prior Authorization or Referral Number
Use this reference number as qualified by the preceding data element (REF01).

C

AN

1/30

Required

1.

R0203 - At least one of REF02,REF03 is required

1.

REF04 contains data relating to the value cited in REF02.

Notes:

1. Use this segment to identify referral or prior authorization numbers for the subscriber. The type of reference number is determined by the qualifier in REF01.
2. Use this segment when it is necessary to provide a referral or prior authorization number for the benefit being inquired about.

Example:

REF*9F*660415~