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278Health Care Service Review Information

This Draft Standard for Trial Use 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.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

    To indicate the start of a transaction set and to assign a control number

  • BHT
    Beginning of Hierarchical Transaction
    M必须(Mandatory)
    Repeat 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

  • HLLoop1Hierarchical Level LOOPM必须(Mandatory)Repeat > 1
    HLTRNAAAUMHCRREFDTPHIHSDCRCCL1CR1CR2CR5CR6MSGNM1Loop1
    • HL
      Hierarchical Level
      M必须(Mandatory)
      Repeat 1

      To identify dependencies among and the content of hierarchically related groups of data segments.

    • TRN
      Trace
      O可选(Optional)
      Repeat 9

      To uniquely identify a transaction to an application.

    • AAA
      Request Validation
      O可选(Optional)
      Repeat 9

      To specify the validity of the request and to indicate follow-up action authorized.

    • UM
      Health Care Services Review Information
      O可选(Optional)
      Repeat 1

      To specify health care services review information

    • HCR
      Health Care Services Review
      O可选(Optional)
      Repeat 1

      To specify the outcome of a health care services review

    • REF
      Reference Numbers
      O可选(Optional)
      Repeat 9

      To specify identifying numbers.

    • DTP
      Date or Time or Period
      O可选(Optional)
      Repeat 9

      To specify any or all of a date, a time, or a time period

    • HI
      Health Care Information Codes
      O可选(Optional)
      Repeat 1

      To supply information related to the delivery of health care

    • HSD
      Health Care Services Delivery
      O可选(Optional)
      Repeat 1

      To specify the delivery pattern of health care services

    • CRC
      Conditions Indicator
      O可选(Optional)
      Repeat 9

      To supply information on conditions

    • CL1
      Claim Codes
      O可选(Optional)
      Repeat 1

      To supply information specific to hospital claims

    • CR1
      Ambulance Certification
      O可选(Optional)
      Repeat 1

      To supply information related to the ambulance service rendered to a patient

    • CR2
      Chiropractic Certification
      O可选(Optional)
      Repeat 1

      To supply information related to the chiropractic service rendered to a patient

    • CR5
      Oxygen Therapy Certification
      O可选(Optional)
      Repeat 1

      To supply information regarding certification of medical necessity for home oxygen therapy

    • CR6
      Home Health Care Certification
      O可选(Optional)
      Repeat 1

      To supply information related to the certification of a home health care patient

    • MSG
      Message Text
      O可选(Optional)
      Repeat 1

      To provide a free form format that would allow the transmission of text information.

    • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
      NM1REFN2N3N4PERAAAPRVDMGINSDTP
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • REF
        Reference Numbers
        O可选(Optional)
        Repeat 9

        To specify identifying numbers.

      • N2
        Additional Name Information
        O可选(Optional)
        Repeat 1

        To specify additional names or those longer than 35 characters in length

      • N3
        Address Information
        O可选(Optional)
        Repeat 1

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 3

        To identify a person or office to whom administrative communications should be directed

      • AAA
        Request Validation
        O可选(Optional)
        Repeat 9

        To specify the validity of the request and to indicate follow-up action authorized.

      • PRV
        Provider Information
        O可选(Optional)
        Repeat 1

        To specify the identifying characteristics of a provider

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • INS
        Insured Benefit
        O可选(Optional)
        Repeat 1

        To provide benefit information on insured entities

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 9

        To specify any or all of a date, a time, or a time period

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 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).

Segment
X12 EDI Release 00305
STTransaction Set Header
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set.

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9

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