REF

Additional Payer Identification

Pos: 120	Max: 4
Heading - Optional
Loop: 1000A	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

2U

Payer Identification Number

For Medicare carriers or intermediaries, use this number for the Medicare carrier or intermediary ID number. For Blue Cross and Blue Shield Plans, use this number for the Blue Cross Blue Shield association plan code.

EO

Submitter Identification Number

This should be considered required when the transaction sender is not the payer or is identified by an identifier other than those already provided.

HI

Health Industry Number (HIN)

CODE SOURCE:

121: Health Industry Identification Number

NF

National Association of Insurance Commissioners (NAIC) Code

ADVISED

CODE SOURCE:

245: National Association of Insurance Commissioners (NAIC) Code

REF02

127

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

C

AN

1/30

Required

ExternalCodeList

Name: 121

Description: Health Industry Identification Number

ExternalCodeList

Name: 245

Description: National Association of Insurance Commissioners (NAIC) Code

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 REF segment whenever additional payer identification numbers are required. The ID numbers available in the TRN and N1 segments should be used before using the REF segment.

Example:

REF*2U*98765~