REF

Previous Certification Identification

Pos: 060	Max: 1
Detail - Optional
Loop: 2000F	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

BB

Authorization Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Previous Certification 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. This is the certification number assigned by the UMO to the original service review outcome associated with this service review. This is not the trace number assigned by the requester.
2. Required if submitting an additional health care services review request associated with a request already processed by the UMO and the certification number previously assigned by the UMO is known.

Example:

REF*BB*A123~