To populate line level REF IDs in electronic claims, enter the ID in Line Notes in the given format
Format
REF:<Qualifier>:<ID>
Permitted Qualifiers
‘9B’,’9D’,’G1′,’2U’,’6R’,’EW’,’X4′,’F4′,’BT’.
For eg. in order to populate Additional/Referring CLIA# on electronic claim should enter the ID in format REF:F4:<CLIA#> to the Line Note. Table describes the qualifiers used.
| Qualifier | Description |
| 9B | REPRICED LINE ITEM REFERENCE NUMBER |
| 9D | ADJUSTED REPRICED LINE ITEM REFERENCE NUMBER |
| G1 | PRIOR AUTHORIZATION |
| 6R | LINE ITEM CONTROL NUMBER |
| EW | MAMMOGRAPHY CERTIFICATION NUMBER |
| X4 | CLINICAL LABORATORY IMPROVEMENT AMENDMENT (CLIA) IDENTIFICATION |
| F4 | REFERRING CLINICAL LABORATORY IMPROVEMENT AMENDMENT (CLIA) FACILITY IDENTIFICATION |
| BT | IMMUNIZATION BATCH NUMBER |
| 9F | REFERRAL NUMBER |