EDI 278-A1 Health Care Services Review — Request for Review

What is EDI 278-A1 Health Care Services Review — Request for Review?

One of the EDI X12 transactions, EDI 278 is sent by healthcare organizations for requesting a review. The EDI 278 transaction set is used to submit information in the following categories:

• Completion notification – for patient arrival or discharge from a facility
• Advance notification – for scheduled inpatient or specialty care
• Change notification – for reporting amendments to previously sent information
• Information copy – for health services review details sent to service providers

EDI X12 278-A1 Health Care Services Review — Request for Review Sample

The following EDI 278-A1 sample file demonstrates the different data elements and segments that are found within an EDI 278-A1 transaction document.

ISA*00* *00* *ZZ*9012345720010 *ZZ*9088877320010 *151010*0817*+*00501*000001523*0*T*~ GS*HI*9012345720010*9088877320010*20151010*0817*1523*X*005010X217~ ST*278*1523*005010X217~
BHT*0007*13*4000000000001*20151010*0817~
HL*1**20*1~
NM1*X3*2*NOVITAS SOLUTIONS INC*****PI*2.16.840.1.113883.13.34.110.1.110.11~[NM109 => RC OID] HL*2*1*21*1~
NM1*1P*1*DOE*JOHN****XX*1234567893~
N3*2545 LORD BALTIMORE DR~
N4*WINDSORMILL*MD*21244~
PER*IC*JAMES WILBER*FX*4105850054*TE*4105850064*EX*7854~
HL*3*2*22*1~
NM1*IL*1*CLINGTON*TONY****MI*212123289A~
N3*7111 SECURITY BLVD~
N4*BALTIMORE*MD*21244~
DMG*D8*19611111*M~
HL*4*3*EV*1~
TRN*1*201503251246005544*HIH1238946~
UM*HS*I*56*41:B~
DTP*AAH*RD8*20151020-20151219~
HI*BK:78609~
PWK*M1*EL***AC*ACN1~
NM1*DK*1*HANDLE*PETER**M.D.**XX*1345678902~
N3*7602 WINDSOR WAY~
N4*WINDSORMILL*MD*21244~
NM1*SJ*1*EATHAN*DUBIN*T***XX*1456789019~
N3*AMBSTREET RENDERING PROVIDER 2010EA ~
N4*WINDSORMILL*MD*21244~
HL*5*4*SS*0~
TRN*1*0070-20150320175012376*9555555555~
SV1*HC:A0428:QM**UN*30~
SE*30*1523~
GE*1*1523~
IEA*1*000001523~

Workflow for the Exchange of EDI 278-A1 Health Care Services Review — Request for Review

One of the X12 transactions, EDI 278-A1 is used either as a one-way transaction for referring to an individual patient event or a two-way inquiry/response transaction. Healthcare service providers generally send an EDI 278-A1 transaction set for requesting a review or reporting the results of a healthcare services review.

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