REF

Dependent Additional Identification

Pos: 040	Max: 9
Detail - Optional
Loop: 2100D	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

18

Plan Number

1L

Group or Policy Number

Use this code only if it cannot be determined if the number is a Group Number or a Policy number. Use codes “IG” or “6P” when they can be determined.

6P

Group Number

A6

Employee Identification Number

CT

Contract Number

This code is to be used only to identify the provider’s contract number of the provider identified in the PRV segment of Loop 2100D. This code is only to be used once the HCFA National Provider Identifier has been mandated for use, and must be sent if required in the contract between the Information Receiver identified in Loop 2100B and the Information Source identified in Loop 2100A.

EA

Medical Record Identification Number

EJ

Patient Account Number

F6

Health Insurance Claim (HIC) Number

GH

Identification Card Serial Number

Use this code when the Identification Card has a number in addition to the Member Identification Number or Identity Card Number. The Identification Card Serial Number uniquely identifies the card when multiple cards have been or will be issued to a member (e.g., on a monthly basis, replacement cards). This is particularly prevalent in the Medicaid environment.

HJ

Identity Card Number

Use this code when the Identity Card Number is different than the Member Identification Number. This is particularly prevalent in the Medicaid environment.

IF

Issue Number

IG

Insurance Policy Number

N6

Plan Network Identification Number

SY

Social Security Number

The social security number may not be used for any Federally administered programs such as Medicare.

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Dependent Supplemental Identifier
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 when needed to convey identification numbers for the dependent. The type of reference number is determined by the qualifier in REF01.
2. Please refer to Section 1.3.8 Search Options for specific information about how to identify an individual to an Information Source.

Example:

REF*1L*660415~