REF

Original Reference Number (ICN/DCN)

Pos: 180	Max: 1
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

F8

Original Reference Number

REF02

127

Reference Identification
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
Industry: Claim Original Reference Number
NSF Reference: EA0-47.0

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. Required when CLM05-3 (Claim Submission Reason code) = “6", ”7" or “8" and the payer has assigned a payer number to the claim. The resubmission number is assigned to a previously submitted claim/encounter by the destination payer or receiver.
2. This segment can be used for the payer assigned Original Document Control Number/Internal Control Number (DCN/ICN) assigned to this claim by the payer identified in the 2010BB loop of this claim. This number would be received from a payer in a case where the payer had received the original claim and for whatever reason, had (1) asked the provider to resubmit the claim and (2) had given the provider the payer’s claim identification number so that the payer can match it in their adjudication system. By matching this number in the adjudication system, the payer knows this is not a duplicate claim.
This information is specific to the destination payer reported in the 2010BB loop. If other payers have a similar number, report that information in the 2330 loop which holds that payer’s information.

Example:

REF*F8*R555588~