REF

Medical Record 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

EA

Medical Record Identification Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Medical Record Number
Found on UB92 record 20 field 25
As submitted on the Dental, Institutional, and Professional 837
Claim in Medical Record Number segment in REF02 (EA)
Found on UB92 paper form locator 23

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 is the Medical Record number submitted on the original claim and should be sent when available from the submitted claim.
2. Use this only if the subscriber is the patient.
3. The total number of REF segments in the 2200 Loop cannot exceed 3.

Example:

REF*EA*J354789~