| |
|
|
|
|
|
|
|
|
|
|
| |
_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
|
|
| |
REF01 |
128 |
Reference Identification Qualifier |
M |
ID |
2/3 |
|
|
| |
|
|
Description: Code qualifying the Reference Identification |
| |
|
|
|
Code |
Name_______________________________ |
| |
|
|
|
18 |
Plan Number |
| |
|
|
|
|
Description: The unique identification number assigned for a defined contribution plan |
| |
|
|
|
1L |
Group or Policy Number |
| |
|
|
|
1W |
Member Identification Number |
| |
|
|
|
49 |
Family Unit Number |
| |
|
|
|
|
Description: An identification number assigned to siblings within the same family |
| |
|
|
|
6P |
Group Number |
| |
|
|
|
9F |
Referral Number |
| |
|
|
|
A6 |
Employee Identification Number |
| |
|
|
|
F6 |
Health Insurance Claim (HIC) Number |
| |
|
|
|
|
Description: A unique number assigned by the government to each person entitled to Medicare benefits |
| |
|
|
|
G1 |
Prior Authorization Number |
| |
|
|
|
|
Description: An authorization number acquired prior to the submission of a claim |
| |
|
|
|
IG |
Insurance Policy Number |
| |
|
|
|
N6 |
Plan Network Identification Number |
| |
|
|
|
|
Description: A number assigned to identify a specific health care network that provides health care services to insured members |
| |
|
|
|
NQ |
Medicaid Recipient Identification Number |
| |
|
|
|
|
Description: Unique identification number assigned to each member covered under a subscriber's contract |
| |
REF02 |
127 |
Reference Identification |
C |
AN |
1/30 |
|
|
| |
|
|
Description: Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier |
| |
REF03 |
352 |
Description |
C |
AN |
1/80 |
|
|
| |
|
|
Description: A free-form description to clarify the related data elements and their content |
