EDI 278 Health Care Services Review Information

What is EDI 278 Health Care Services Review Information?

This EDI X12 transaction is sent by healthcare organizations for requesting a review. EDI 278 documents can also be used when referring a patient to a healthcare service provider. This 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 Health Care Services Review Information Sample

The following sample file demonstrates the different data elements and segments that are found within an EDI 278 transaction document[1].

ST*278*0032*005010X217~
BHT*0007*13*0001*20100101*000000~
HL*1**20*1~
NM1*X3*2*BLUE CROSS BLUE SHIELD NC*****46*560894904~
HL*2*1*21*1~
NM1*1P*1*HELBY*MARCUS****XX*1111122222~
N3*200 GETWELL AVENUE~
N4*JEFFERSON*NC*28640~
PER*IC**TE*9194567890~
HL*3*2*22*1~
NM1*IL*1*RUBBLE*BARNEY****MI*YPPW1234567890~
DMG*D8*19460401*M~
HL*4*3*23*1~
NM1*QC*1*RUBBLE*BARNEY~
DMG*D8*19460401*M~
HL*5*4*EV*1~
UM*AR*I*4*21:B***2*3*M~
DTP*435*D8*20100101~
DTP*096*D8*20100101~
HI*BF:41090:D8:20050125~
HSD*DY*4~
CL1*3*1~
NM1*FA*2*FLINTSTONE UNIVERSITY HOSPITAL*****XX*1001234567~
N3*THELMA LANE~
N4*DURHAM*NC*27705~
HL*6*5*SS*0~
TRN*1*TS32-2*90004N7891~
DTP*472*RD8*20100101-20100101~
SV2**HC:33510~
NM1*1T*1*HELBY*MARCUS****XX*1111122222~
SE*31*0032~
GE*1*36~

Workflow for the Exchange of EDI 278 Health Care Services Review Information

This transaction set falls under the category of the X12N Insurance transactions. Healthcare service providers use an EDI 278 either as a one-way transaction for referring to an individual patient event or a two-way inquiry/response transaction.

Stay EDICompliant with Astera EDIConnect

Designed to facilitate electronic data interchange, Astera EDIConnect is an enterprise-grade, code-free solution that supports EDIFACT and ANSI X12 EDI formats. With a built-in parser, validator, and transaction builder, Astera EDIConnect makes the process of sending and receiving EDI documents simple and easy.

[1] https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/278_5010_v1.1.pdf