REF

Institutional Bill Type Identification

Pos: 100	Max: 1
Detail - Optional
Loop: 2200D	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

REF01

128

Reference Identification Qualifier
Description: Code qualifying the Reference Identification

M

ID

2/3

Required

Code

Name

BLT

Billing Type

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Bill Type Identifier
Found on UB92 - record 40 - 4
As submitted on the Institutional 837 claim in composite element CLM05.
Found on UB92 paper form locator 4
Required for institutional claims inquiries.

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. This segment is the institutional bill type submitted on the original claim. The institutional bill type consists of the two position, Facility Type Code, and the one position, Claim Frequency Code. The payer may use it as a primary lookup key.
2. Only use this segment if the subscriber is the patient and bill type is being sent in the inquiry request in connection with an institutional bill.
3. The total number of REF segments in the 2200 Loop cannot exceed 3.

Example:

REF*BLT*111~