REF

Predetermination Identification

Pos: 180	Max: 5
Detail - Optional
Loop: 2300	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

G3

Predetermination of Benefits 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: Predetermination of Benefits Identifier
NSF Reference: FD0-26.0

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. Reference numbers at this position apply to the entire claim.
2. This REF segment is used to send the Predetermination of Benefits Identification Number for a claim that has been previously predetermined and is now being submitted for payment.

Example:

REF*G3*13579~