REF

Institutional Bill Type Identification

Pos: 100	Max: 1
Detail - Optional
Loop: 2200E	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
Found on 837 CLM-05
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 type of bill as submitted on the original claim, and the payer may use it as a lookup key.
2. Use this segment only if the dependent is the patient and bill type is being sent in the inquiry request in connection with an institutional bill.

Example:

REF*BLT*111~