REF

Subscriber Additional Identification

Pos: 040

Max: 9

Detail - Optional

Loop: 2100C

Elements: 3

User Option (Usage): Situational

To specify identifying information

Element Summary:

	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

Plan Number

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.

Member Identification Number

Use only if Loop 2100C NM108 contains ZZ, and is prior to the mandated use of the HIPAA Unique Patient Identifier.

Case Number

Family Unit Number

This is the Suffix to the Subscriber’s Member Identification Number, which allows the information source to use one identification number as the base number for each family member. The suffix
identifies the individual family member. Only the suffix is to be entered here. The Member Identification Number is to be entered in Loop 2100C NM109 or REF02. If the complete Member Identification Number with the suffix is entered in Loop 2100C NM109 or REF02, the suffix should not be entered here.

Group Number

Employee Identification Number

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 2100C. 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.

Medical Record Identification Number

Patient Account Number

Health Insurance Claim (HIC) Number

See segment note 3.

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.

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.

Issue Number

Insurance Policy Number

Military Rank/Civilian Pay Grade Number

If conveying a Military rank see Code Source DOD1: Military Heatlh Systems Functional Area Manual -Data.
If conveying a Civilian Pay Grade Number see Code Source DOD2: Department of Defense Instruction (DODI) 1000.13.

Plan Network Identification Number

Medicaid Recipient Identification Number

See segment note 2.

Prior Identifier Number

This code is to be used when a corrected or new identification number is returned in NM109, the originally submitted identification number is to be returned in REF02. To be used in conjunction with code “001" in INS03 and code ”25" in INS04.

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: Subscriber Supplemental Identifier
Use this information for the reference number as qualified by the preceding data element (REF01).

1/30

Required

	ExternalCodeList
	Name: DOD1
	Description: Military Heatlh Systems Functional Area Manual - Data.

	ExternalCodeList
	Name: DOD2
	Description: Department of Defense Instruction (DODI) 1000.13.

REF03

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Plan Sponsor Name
Use if available.

1/80

Situational

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 supply an identification number other than or in addition to the Member Identification Number. The type of reference number is determined by the qualifier in REF01.
2. Required if the Information Source requires additional identifiers necessary to identify the Subscriber for other transactions such as claims, authorizations, etc.
3. Health Insurance Claim (HIC) Number or Medicaid Recipient Identification Numbers are to be provided in the NM1 segment as a Member Identification Number when it is the primary number an information source knows a member by (such as for Medicare or Medicaid). Do not use this segment for the Health Insurance Claim (HIC) Number or Medicaid Recipient Identification Number unless they are different from the Member Identification Number provided in the NM1 segment.
4. If the 270 request contained a REF segment with a Patient Account Number in Loop 2100C/REF02 with REF01 equal EJ, then it must be returned in the 271 transaction using this segment.

Example:

REF*18*660415~