REF

Premium Receivers Identification Key

Pos: 050	Max: >1
Heading - Optional
Loop: N/A	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

14

Master Account Number

For HIPAA Health Premium Payments this element is REQUIRED.

18

Plan Number

2F

Consolidated Invoice Number

38

Master Policy Number

72

Schedule Reference Number

For U.S. Treasury Department Financial Management Service Disbursed payments, this code indicates a payment schedule number will follow.

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Health Care Industry: Premium Receiver Reference Identifier
For Treasury Department Financial Management Service Disbursed payments, this data field is schedule number (11 Characters) submitted by the agency authorizing the payment.

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 used to provide the premium receiver a key associated with this premium payment. The type of key and value is provided to the premium payer by the premium receiver. Examples of keys are Plan Number, Master Account Number, Consolidated Invoice Number, and Master Policy Number.
2. For HIPAA Health Premium Payments one occurrence of this segment is REQUIRED to identify the Master Account Number.

Example:

REF*18*123456789~