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Back  RFI # 247: 2300 REF01=9F, 2310A presence

Formal vs. Informal Help Informal Formal

Submitter

Kim White

Description

If the 2300 REF01=9F (Referral Number) is present, does the 2310A Loop become required? Per comments in the IG, our interpretation is Yes. Page 282 of the IG for 2310A item number 4 states: Required if claim involved a referral. We have a submitter that states "A referral and a referral number are not the same entities" therefore they say ithe 2310A is not required if the 2300 REF segment is present.

Would there ever be a situation where a referral number would be sent in the 2300-REF segment and the 2310A Loop is not required?

Submitter Assigned Keywords

Referral

Response

This is explicitly addressed in guide 004010X098. While the 2310A loop can occur without the presence of a referral number in the 2300 loop Prior Authorization or Referral Number REF segment, the presence of a referral number indicates that a referral is applicable to the claim. Therefore, the 2300 loop referral number without the 2310A loop is inconsistent.
Submission 4/22/2005
Status Date 6/27/2005
Status F - Final
Primary References
Document 004010X098A1
Section2310A
Page282
Set ID837P
Table2
Loop2310A
Secondary References
RFI ID 207
Document 004010X098A1
Section2300
Page227
Set ID837P
Table2
Loop2300
Segment Position180
Segment IDREF
Industry NamePrior Authorization or Referral Number