REF

Medical Record 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

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
Found on 837 REF-02
Found on UB92 paper form locator 23
Found on REF02, Loop ID 2210, segment REF01, qualifier EA.

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 returned when available from the the submitted claim.
2. Use this if the patient is someone other than the subscriber.

Example:

REF*EA*J354789~