EDI 5010 Documentation 837 Professional - 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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