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Back   Health Care Services Request for Review and Response (005010X217)

Purpose

The Health Care Services Review Request and Response Implementation Guide describes the use of the ANSI ASC X12 Health Care Services Review Information (278) Version/Release 005010 transaction set for the following business usages:
  • Health care admission certificate requests and responses
  • Referral requests and responses
  • Health care services certification requests and responses
  • Extend certification requests and responses
  • Certification appeal requests and responses

Primary Trading Partners

Trading partners include:
  • Health care providers, such as hospitals, physicians, medical groups, independent physician associations, and facilities
  • Health care review entities, such as insurance companies, HMOs, PPOs, health care purchasers, professional review organizations, and other utilization review organizations.

Exceptions/Limitations

Does not include health care services review for patient arrival, transfer, and discharge notices; certification change notices; and medical therapy supporting information.

References

  • Health Care Services Request for Review and Response (003070X004)
  • Health Care Services Request for Review and Response (004010X094)
  • Health Care Services Request for Review and Response (004050X140)
  • Health Care Services Request for Review and Response (004060X198)

Coordination

No coordination required at this time with other ANSI ASC X12 groups.

Additional Information

Registered 10/2/2003 Published 5/5/2006
Transaction Set ID 278 Standard Version 005010
ASC X12 DM# Owning Group X12N/TG2/WG10