Segment: REF

Loop:2300 Segment: REF

Element: REF01 (Service Authorization Exception Code Qualifier)

Hard Coded to'4N'

Element: REF02 (Service Authorization Exception Code)

TBD

Element:..... (Mandatory Medicare Crossover Indicator)

Submitter is Medicare

Element: REF01 (Mammography Certification Number Qualifier)

Hard Coded to 'EW'

Element: REF02 (Mammography Certification Number) Size Limit 50

Element: REF02 (Mammography Certification Number) Size Limit 50

Billing->Patient Account->Claims tab->More Info->Mammography Certification Number

Element: REF01 (Referral Number Qualifier)

Hard Coded to '9F'

Element: REF02 (Referral Number)

Element: REF02 (Referral Number)

Billing->Patient Account->Claims tab->Select Visit->More Info->Referral/Authorization tab->Referral Number

Element: REF01 (Prior Authorization Qualifier)

Hard Coded to 'G1' Need one for each payer

Element: REF02 (Prior Authorization) Size Limit 50

Element: REF02 (Prior Authorization) Size Limit 50

Billing->Patient Account->Claims tab->Select Visit->More Info->Referral/Authorization tab->Prior Authorization Number. Need one for each payer.

Element: REF01 (Payer Claim Control Number Qualifier)

Hard Coded to 'F8'.  Need one for each payer

Element: REF02 (Payer Claim Control Number)

Element: REF02 (Payer Claim Control Number)
  1. Open the Patient Account.
  2. Click on the Claims tab.
  3. Select the claim.
  4. Click on More Info.
  5. Click the Misc Details tab.
  6. Under Original Reference Number section, click drop down for Policy ID and select the policy that the claim control number relates to.
  7. Under the Number field, type in the control claim number that was given from the payer for the claim.

Below is a sample of what this will look like in the 837P electronic file:

REF✽F8✽R555588~

Element: REF01 (CLIA Number Qualifier)

Hard Coded to 'X4'

Element: REF02 (CLIA Number) Size Limit 50

Element: REF02 (CLIA Number) Size Limit 50

Tools->Manage Facilities->CLIA

Element: REF02 (CLIA Number) #2 Size Limit 50

Element: REF02 (CLIA Number) #2 Size Limit 50

Billing->Patient Account->Claims tab->Select Visit->More Info->Misc Details tab->Lab (select from drop down)

Element:.... (Repriced Claim Number)

N/A

Element:.... (Adjusted Repriced Claim Number)

N/A

Element: REF01 (Investigational Device Exemption Number Qualifier)

Hard Coded to 'LX'

Element: REF02 (Investigational Device Exemption Number) Size Limit 50

Element: REF02 (Investigational Device Exemption Number) Size Limit 50

Billing->Patient Account->Claims tab->Select Visit->More Info->Misc Details tab->Investigational Device Exemption Number

Element:...(Claim Identifier for Transmission Intermediaries)

N/A

Element: REF01 (Medical Record Number Qualifier)

Hard Coded to 'EA'

Element: REF02 (Medical Record Number) Size Limit 50

Element: REF02 (Medical Record Number) Size Limit 50

Billing->Patient Account->Claims tab->Select Visit->More Info->Misc Details tab->Medical Record Number

Element: REF01 (Demonstration Project Identifier Qualifier)

Hard Coded

Element: REF02 (Demonstration Project Identifier) Size Limit 50

Element: REF02 (Demonstration Project Identifier) Size Limit 50

Billing->Patient Account->Claims tab->Select Visit->More Info->Misc Details tab->Demonstration Project ->Identifier

Element: REF01 (Care Plan Oversight Qualifier)

Hard Coded to '1J'

Element: REF02 (Care Plan Oversight)

Element: REF02 (Care Plan Oversight)

Billing->Patient Account->Claims tab->Select Visit->More Info->Misc Details tab->Care Plan Oversight ->Number