Segment: REF

Loop: 2400  Element: REF1

Repricing-N/A

Repriced Line Item Reference Number and Adjusted Repriced Line Item Reference Number - N/A

Element: REF01 (Prior Authorization Reference Id Qualifier)

Hard coded to 'G1'.

Element: REF02 (Prior Authorization Number)

Element: REF02 (Prior Authorization Number)

Edit Charge->Referral/Authorization Tab->Authorization Number

Element: REF04-1 (Prior Authorization Other Payer Primary Reference ID Qualifier)

Hard coded to '2U'.

Element: REF04-2 (Prior Authorization Other Payer Primary Identifier)

Generated from Loop 2300.

Element: REF01 (Line Item Control Number Reference ID Qualifier)

Hard coded to '6R'.

Element: REF02 (Line Item Control Number)

Charge ID (in database)

Element: REF01 (Mammography Certification Number Reference Id Qualifier)

Hard coded to 'EW'.

Element: REF02 (Mammography Certification Number)

Element: REF02 (Mammography Certification Number)

Edit Charge->Misc Details Tab-> Mammography Certification Number

Element: REF01 (CLIA Number Reference Id Qualifier)

Hard coded to 'X4'.

Element: REF02 (CLIA Number)

Element: REF02 (CLIA Number)

Edit Charge->Misc Details Tab->Lab

Element: REF01 (Referring CLIA Facility Reference Id Qualifier)

Hard coded to 'F4'.

Element: REF02 (Referring CLIA Facility Number)

Element: REF02 (Referring CLIA Facility Number)

Edit Charge->Misc Tab->Referring Lab

Element: REF01 (Immunization Batch Number Reference Id Qualifier)

Hard coded to 'BT'.

Element: REF02 (Immunization Batch Number)

Element: REF02 (Immunization Batch Number)

Edit Charge->Misc Details Tab->Batch Number

Element: REF01 (Referral Number Reference Id Qualifier)

Hard coded to '9F'.

Element: REF02 (Referral Number)

Element: REF02 (Referral Number)

Edit Charge->Referral/Authorization->Referral Number

Element: REF04-1 (Referral Number Other Payer Primary Reference ID Qualifier)

Hard coded to '2U'.

Element: REF04-2 (Referral Number Other Payer Primary Reference ID Qualifier)

Generated from Loop 2300