EDI 278 Health Care Services Review Information Specifications
The EDI 278 transaction set is called Health Care Services Review Information. A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from a payer, such as an insurance company. The hospital is asking the insurance company to review proposed healthcare services to be provided to a given patient, in order to obtain an authorization for these services.
The 278 transaction can be used to submit information in the following categories:
- Advance notification – for scheduled inpatient, specialty care or other services
- Completion notification – for patient arrival to or discharge from a facility
- Information copy – for any health services review information sent to service providers
- Change notification – for reporting changes to previously sent information
EDI 278 Format
EDI 278 Specification
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.
Sources
Accredited Standards Committee X12. ASC X12 Standard [Table Data]. Data Interchange Standards Association, Inc., Falls Church, VA. http://www.x12.org