REF

Service Identification

Pos: 100	Max: 7
Detail - Optional
Loop: 2110	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

1S

Ambulatory Patient Group (APG) Number

6R

Provider Control Number

This is the Line Item Control Number submitted in the 837, which is utilized by the provider for tracking purposes, if submitted on the claim this must be returned on remittance advice.

BB

Authorization Number

E9

Attachment Code

G1

Prior Authorization Number

G3

Predetermination of Benefits Identification Number

LU

Location Number

RB

Rate code number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Provider 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 REF segment for reference numbers specific to the service identified by the SVC segment. This is used to provide additional information used in the process of adjudicating this service.

Example:

REF*RB*100~