Friday, 4 November 2011

EDI 5010 Documentation – 837 Institutional - Loop 2300 Prior Authorization or Referral Number

2300 Prior Authorization or Referral Number

 
        



Required where services on this claim were preauthorized or where a referral is involved. Generally, preauthorization/referral numbers are
those numbers assigned by the payer to authorize a service prior to its being performed

Pre Certification  or Prior Authorization
A requirement that you obtain the insurance company's approval before a medical service is provided. If you fail to follow the pre-certification procedures the company may reduce or deny claim payment. Please note: getting pre-certification does not guarantee claim payment. Also called Utilization Review.
Prior authorization is a requirement that your physician obtain approval from your health plan to prescribe a specific medication for you. Without this prior approval, your health plan may not provide coverage, or pay for, your medication.

Loop Seg ID Segment Name Format Length Ref# Req Value
2300 REF Prior Authorization or Referral Number ID 3 R REF
Element Separator AN 1 *
REF01 Reference Identification Qualifier ID 2/3 128 R 9F Referral Number
Element Separator AN 1 *
REF02 Reference Identification AN 1/50 127 R Print the Referral Number
Segment Terminator ~
2300 REF Prior Authorization or Referral Number ID 3 R REF
Element Separator AN 1 *
REF01 Reference Identification Qualifier ID 2/3 128 R G1 Prior Authorization Number
Element Separator AN 1 *
REF02 Reference Identification AN 1/50 127 R Print the Referral Number
Segment Terminator


 
        
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