278 - Health Care Services Review Information

FUNCTIONAL GROUP=HI

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Services Review Information Transaction Set (278) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of request for review, certification, notification or reporting the outcome of a health care services review.

Expected users of this transaction set are payors, plan sponsors, providers, utilization management and other entities involved in health care services review.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BHT	Beginning of Hierarchical Transaction	0200

HL

Segment	Name	Position
HL	Hierarchical Level	0100
TRN	Trace	0200
AAA	Request Validation	0300
UM	Health Care Services Review Information	0400
HCR	Health Care Services Review	0500
REF	Reference Information	0600
DTP	Date or Time or Period	0700
HI	Health Care Information Codes	0800
SV1	Professional Service	0810
SV2	Institutional Service	0820
SV3	Dental Service	0830
TOO	Tooth Identification	0840
DN2	Tooth Summary	0850
DRA	Drug Authorization	0860
HSD	Health Care Services Delivery	0900
CRC	Conditions Indicator	1000
CL1	Claim Codes	1100
CR1	Ambulance Certification	1200
CR2	Chiropractic Certification	1300
CR4	Enteral or Parenteral Therapy Certification	1350
CR5	Oxygen Therapy Certification	1400
CR6	Home Health Care Certification	1500
CR7	Home Health Treatment Plan Certification	1520
CR8	Pacemaker Certification	1530
PWK	Paperwork	1550
MSG	Message Text	1600

NM1

Segment	Name	Position
NM1	Individual or Organizational Name	1700
REF	Reference Information	1800
N2	Additional Name Information	1900
N3	Party Location	2000
N4	Geographic Location	2100
PER	Administrative Communications Contact	2200
AAA	Request Validation	2300
PRV	Provider Information	2400
DMG	Demographic Information	2500
INS	Insured Benefit	2600
DTP	Date or Time or Period	2700
SE	Transaction Set Trailer	2800

rev 02/12/2024