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_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
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| |
REF01 |
128 |
Reference Identification Qualifier |
M |
ID |
2/3 |
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| |
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Description: Code qualifying the Reference Identification |
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Code |
Name_______________________________ |
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18 |
Plan Number |
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Description: The unique identification number assigned for a defined contribution plan |
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1L |
Group or Policy Number |
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1W |
Member Identification Number |
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49 |
Family Unit Number |
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Description: An identification number assigned to siblings within the same family |
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6P |
Group Number |
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EA |
Medical Record Identification Number |
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Description: A unique number assigned to each patient by the provider of service (hospital) to assist in retrieval of medical records |
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EJ |
Patient Account Number |
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Description: A unique number assigned to each patient by the provider of service to facilitate retrieval of individual case records tracking of claims submitted to a payer and posting of payment |
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F6 |
Health Insurance Claim (HIC) Number |
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Description: A unique number assigned by the government to each person entitled to Medicare benefits |
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GH |
Identification Card Serial Number |
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HJ |
Identity Card Number |
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Description: Number assigned to an individual by a government |
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IF |
Issue Number |
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IG |
Insurance Policy Number |
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M7 |
Medical Assistance Category |
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N6 |
Plan Network Identification Number |
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Description: A number assigned to identify a specific health care network that provides health care services to insured members |
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NQ |
Medicaid Recipient Identification Number |
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Description: Unique identification number assigned to each member covered under a subscriber's contract |
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Q4 |
Prior Identifier Number |
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SY |
Social Security Number |
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REF02 |
127 |
Reference Identification |
C |
AN |
1/30 |
|
|
| |
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Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier |
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REF03 |
352 |
Description |
C |
AN |
1/80 |
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Description: A free-form description to clarify the related data elements and their content |
