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Back   Health Care Services Review Inquiry/Response (004010X059)

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

  • 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

This is the first implementation guide for this business purpose.

Coordination

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

Additional Information

Registered 9/20/1996 Published 2/1/2001
Transaction Set ID 278 Standard Version 004010
ASC X12 DM# Owning Group X12N/TG2/WG10