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 2100D NM108 contains ZZ, and is prior to the mandated use of the HIPAA Unique Patient Identifier.

Family Unit Number

This is the suffix to the Dependent’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 2100D NM109 or REF02, the suffix should not be entered here.

Group Number

Employee Identification Number

Contract Number

Medical Record Identification Number

Patient Account Number

Health Insurance Claim (HIC) Number

See segment note 2.

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

Medical Assistance Category

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: Dependent Supplemental Identifier Use this information for the reference number as qualified by the preceding data element (REF01).	C	AN	1/30	Required
	REF03	352	Description Description: A free-form description to clarify the related data elements and their content Industry: Plan Sponsor Name Use if available.	C	AN	1/80	Situational

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 2100D/REF02 with REF01 equal EJ, then it must be returned in the 271 transaction using this segment.

Example:

REF*18*660415~
REF*49*03~

	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