REF

Other Payer Secondary Identifier

Pos: 355	Max: 3
Detail - Optional
Loop: 2330B	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

D8

Loss Report Number

Used to indicate the payer’s claim number for this claim for the payer identified in this iteration of the 2330B loop.

F8

Original Reference Number

FY

Claim Office Number

NF

National Association of Insurance Commissioners (NAIC) Code

CODE SOURCE:

245: National Association of Insurance Commissioners (NAIC) Code

TJ

Federal Taxpayer's Identification Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Other Payer Secondary Identifier
NSF Reference: DA3-29.0
The DA3-29.0 crosswalk is only used in payer-to-payer COB situations.

C

AN

1/30

Required

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. Required when a secondary identification number is necessary to identify the entity. The primary identification number should be carried in the NM109 of this loop.
2. Used when it is necessary to identify the ’other’ payer’s claim number.
3. There can only be a maximum of three REF segments in any one iteration of the 2330 loop.
4. See section 1.4.2 Coordination of Benefits for more information on handling COB in the 837.

Example:

REF*FY*435261708~