REF

Claim Submitter Credit/Debit Card Information

Pos: 035	Max: 8
Detail - Optional
Loop: 2010AA	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

06

System Number

8U

Bank Assigned Security Identifier

EM

Electronic Payment Reference Number

IJ

Standard Industry Classification (SIC) Code

LU

Location Number

RB

Rate code number

ST

Store Number

TT

Terminal Code

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Billing Provider Credit Card 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. See Appendix G for use of this segment.
2. The information carried under this segment must never be sent to the payer. This information is only for use between a provider and a service organization offering patient collection services. In this case, it is the responsibility of the service to remove this segment before forwarding the claim to the payer.

Example:

REF*8U*1112223333~