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Back   Health Care Services Review Inquiry/Response (006020X264)

Purpose

The Health Care Services Review Inquiry/Response Implementation Guide describes the use of the ANSI ASC X12 Health Care Services Review Information (278) transaction set for the following business usages:
  • Make inquiries to utilization management organizations for information on previously processed health care services
  • Send response(s) to inquiry(ies) on previously processed health care services

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

Intended for use within the health care industry.

References

  • Health Care Services Review Inquiry/Response (004010X059)
  • Health Care Services Review Inquiry/Response (005010X215)

Coordination

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

Additional Information

Registered 2/1/2007
Transaction Set ID 278 Standard Version 006020
ASC X12 DM# Owning Group X12N/TGB