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Spotlight PEPPOL BIS Billing 3.0 The EU e-invoicing mandate is here — France Sept 2026, Belgium Jan 2026, Germany 2025.

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Foundations

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Standards

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Flagship messages

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Tools

REF^I12 — Patient Referral

Patient referral from referring provider to specialist. Core of city-to-hospital workflows and Healthcare Information Exchange.

Purpose

REF^I12 carries an initial referral from referrer to specialist. The message transports: patient identification (PID), both provider identifications via PRD (referring and referred-to), clinical justification via RF1 and notes via NTE. A prior authorisation can be attached via AUT.

Segment structure

Structure REF_I12: MSH, RF1, [AUT], [PRD] (referring), [PRD] (referred-to), PID, [NK1], [GT1], [INS], [ACC], [DG1], [DRG], [AL1], [PR1], [OBR/OBX], NTE.

SegmentRole
RF1Referral Information — status, priority, type, reason.
PRDProvider Data — referrer + receiver (one PRD per role).
AUTAuthorization — payer prior authorisation (optional).
DG1Diagnosis — primary diagnosis motivating referral.

Real-world example

Cardiologist referral by GP in Lyon (second opinion):

plaintext ref-i12-example.hl7 
MSH|^~\&|GP_EMR|GP_LYON|HOSP_EMR|HOSP01|20260518111500||REF^I12^REF_I12|REFI12001|P|2.5.1|||AL|NE
RF1|P^Pending^HL70283|H^High^HL70280|MEDREF^Medical Referral^HL70281|2nd^Second Opinion^HL70282|REF20260518001||20260518|20260601|REF99001
PRD|RP^Referring Provider^HL70286|DUPONT^MARIE^^^DR.||135 RUE PAUL BERT^^LYON^^69003^FRA||(33)4-78-99-99-99|RPPS10001501234
PRD|RT^Referred-to Provider^HL70286|MARTIN^PIERRE^^^DR.||1 PLACE D'ARSONVAL^^LYON^^69003^FRA||(33)4-72-11-00-00|RPPS10004409876
PID|1||MR300999^^^HOSP^MR||COLIN^EVE^^^MS.||19790922|F||C||14 AV THIERS^^LYON^^69006^FRA
PV1|1|O|CARDIO^^^HOSP01
NTE|1||Suspected stable ischemic heart disease ; abnormal resting ECG.

Acknowledgment (ACK)

plaintext ack-i12-example.hl7 
MSH|^~\&|HOSP_EMR|HOSP01|GP_EMR|GP_LYON|20260518111502||ACK^I12^ACK|ACKI12001|P|2.5.1
MSA|AA|REFI12001

Common errors

  • Only one PRD: spec demands RP (referring) AND RT (referred-to) — two PRD segments.
  • RF1-1 missing: without Pending/Accepted/Rejected status, the workflow stalls.
  • Poorly formatted RPPS / NPI: PRD-7 must carry the verifiable national identifier.
  • Confusion with I13/I14: I12 is original, I13 = modification, I14 = cancellation.
  • REF^I13 — Modification of Patient Referral.
  • REF^I14 — Cancellation of Patient Referral.
  • ADT^A04 — follow-up outpatient registration.
  • ORM^O01 — associated orders.