278 EDI Transaction (Response) example – raw data and human readable
In our previous posts we have already spoke about 278 EDI Transaction. We mentioned definition and purposes of the 278 EDI Transaction and reviewed 278 EDI Transaction (Request) example. The following is a turn-around from the previous 278 EDI Transaction request. The HRC segment authorizes the consultation with a date range in the DTP segment.
278 EDI Transaction (Response) Raw Data
ST*278*1120*005010X217
BHT*0078*11*4158609887*20120107*1341*18
HL*1**20*1
NM1*X3*2*INSURANCE R US*****46*13579
HL*2*1*21*1
NM1*1P*1*Zoidberg*John****46*12293
HL*3*2*22*1
HI*BF:78550:D8:20120122
HL*4*3*19*1
NM1*SJ*1*Armstrong*Edward*G***34*123456789
PER*IC**TE*8584537845
PRV*CO*ZZ*203BP0800Y –> describes service provider’s role
HL*5*4*SS*0
TRN*2*051036622050010*1262721578
UM*SC*I*3*11:B –> Health Care Service Review Information
HCR*A1*3278932~
HSD*VS*1 –> Health Care Service Delivery details
DTP*472*RD8*20090810-20090828~
SE*19*1120
278 EDI Transaction (Response) Human Readable
Beginning of Hierarchical Transaction: BHT*0078*11*4158609887*20120107*1341*18
Hierarchical Structure Code : Source, Receiver, Subscriber, Dependent, Provider of Service, Services
Transaction Set Purpose Code : Response (Code ‘11’ in BHT02 indicates response)
Reference Identification : 4158609887
Date : 8/7/2009
Time : 1:41:00 PM
Transaction Type Code : Response – No Further Updates to Follow (Code ‘18’ in BHT-06)
HL*1**20*1 Information Source Level
Individual or Organizational Name: NM1*X3*2*INSURANCE R US*****46*13579
Entity Identifier Code : Utilization Management Organization
Entity Type Qualifier : Non-Person Entity
Name Last or Organization Name : INSURANCE R US
Identification Code Qualifier : Electronic Transmitter Identification Number (ETIN)
Identification Code : 13579
HL*2*1*21*1 Information Receiver Level
Individual or Organizational Name: NM1*1P*1*Zoidberg*John****46*12293
Entity Identifier Code : Provider
Entity Type Qualifier : Person
Name Last or Organization Name : Zoidberg
Name First : John
Identification Code Qualifier : Electronic Transmitter Identification Number (ETIN)
Identification Code : 12293
HL*3*2*22*1 Subscriber level
Health Care Information Codes: HI*BF:78550:D8:20120122
Diagnose Code: BF:78550 Diagnose Date: 8/6/2009
Individual or Organizational Name:
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : Flintstone
Name First : Fred
Identification Code Qualifier : Member Identification Number
Identification Code : MID987654321
HL*4*3*19*1 Provider of Service Level
Individual or Organizational Name:
Entity Identifier Code : Service Provider
Entity Type Qualifier : Person
Name Last or Organization Name : Armstrong
Name First : Edward
Name Middle : G
Identification Code Qualifier : Social Security Number
Identification Code : 123456789
Contact Information:
Information Contact : Telephone : 8584537845
HL*5*4*SS*0 Services level
Trace: TRN*2*051036622050010*1262721578
Trace Type Code : Referenced Transaction Trace Numbers
Reference Identification : 051036622050010
Originating Company Identifier : 1262721578
Health Care Services Review Information: UM*SC*I*3*11:B
Request Category Code : Specialty Care Review
Certification Type Code : Initial
Service Type Code : Consultation
Health Care Service Location Information : 11:B
Health Care Services Review: HCR*A1*3278932
Action Code : Certified in total
Reference Identification : 3278932
Health Care Services Delivery: HSD*VS*1 Date Range Set By Insurance Company for Visit:
Quantity Qualifier : Visits DTP*472*RD8*20090810-20090828
Quantity : 1 Date Range: 8/10/09 – 8/28/09