REF

Dependent Additional Information

Pos: 190	Max: 1
Detail - Optional
Loop: 2110D	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 dependent.
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~