EDI 278-A3 Health Care Services Review — Response to Request for Review

What is EDI 278-A3 Health Care Services Review — Response to Request for Review? 

One of the X12 transactions, EDI 278-A3 is used for conveying the claim status review information. This transaction set is commonly used by plan sponsors, providers, payors, and other bodies involved in the healthcare service review process.

EDI X12 278-A3 Health Care Services Review — Request for Review Sample

An EDI 278-A3 document is divided into different functional groups that explain the contents of the transaction being conducted. A sample EDI 278-A3 document looks like this[1].

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-A3 Health Care Services Review — Request for Review

The EDI 278-A3 transaction 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-A3 transaction set for requesting a review or reporting the results of a healthcare services review.

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[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and Systems/ESMD/Downloads/esMD_X12_278_09_2016Companion_Guide.pdf