REF

Dependent Supplemental Identification

Pos: 180	Max: 3
Detail - Optional
Loop: 2010DA	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

A6

Employee Identification Number

EJ

Patient Account Number

SY

Social Security Number

The social security number may not be used for Medicare.

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Dependent Supplemental Identifier

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 when necessary to provide supplemental identifiers for the dependent.
2. Use the Subscriber Supplemental Identifier (REF) segment in Loop 2010C for supplemental identifiers related to the subscriber’s policy or group number.
3. If the requester values this segment with the Patient Account Number ( REF01 = “EJ”) on the request, the UMO must return the same value in this segment on the response.

Example:

REF*SY*123456789~