EDI 278 Health Care Services Review Information

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.

Segments

Position
Segment
Name
Max use
100
ST
Transaction Set Header
Mandatory
AtMax 1
To indicate the start of a transaction set and to assign a control number
200
BHT
Beginning of Hierarchical Transaction
Mandatory
AtMax 1
To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time
2000
LOOP
Mandatory
GT 1
2800
SE
Transaction Set Trailer
Mandatory
AtMax 1
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Elements

PositionElementNameRequirementTypeMin/MaxRepeat
1
143
Transaction Set Identifier CodeMandatoryID3/31
2
329
Transaction Set Control NumberMandatoryAlphanumeric4/91
3
1705
Implementation Convention ReferenceOptAlphanumeric1/351