REF

Institutional Bill Type Identification

Pos: 110	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 institutional claim 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 is the institutional type of bill from the original submitted claim, and it is returned when it is available.
2. This is used if the dependent is the patient.

Example:

REF*BLT*111~