REF

Service Line Item Identification

Pos: 140	Max: 1
Detail - Optional
Loop: 2210D	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

FJ

Line Item Control Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Line Item Control Number
May or may not help the payer in the identification of the claim.

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 if the subscriber is the patient.
2. Required when available from the original claim. When the Information Receiver is the Provider, this is required when the number was assigned by the provider on the original claim.
3. Will be used primarily for professional claim service line inquiry, and bill type is being sent in the inquiry request in connection with institutional bill.

Example:

REF*FJ*6042201~