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

    January 15th, 2020

    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.

    Achieve EDICompliance with Astera EDIConnect

    Astera EDIConnect facilitates the exchange of EDI documents by allowing businesses to translate as well as construct EDI messages. Featuring an intuitive EDI transaction parser, validator, and builder, Astera EDIConnect delivers the performance and scalability to efficiently process EDI files of any complexity and size.

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

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    Authors:

    • Iqbal Ahmed
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