Health Care Services Review (278) Defaults

Create values to populate entries for the 278 file in the Health Care Services (278) Review Request form.

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• Default entries must be made in the Request Defaults section before any 278 request inbound files can be successfully loaded and compiled.

• The 2010A NM102, NM108 and NM109 segments in the inbound 278 request file must match the NM102, NM108 and NM109 entries in this form, or the request will be rejected.

The following fields identify the funding source and benefit plan when a 278 request file is processed:

1. In the Entity Type Qualifier (2010A-NM1-02) field, select the type of UMO (utilization management organization) entity.

2. In the Identification Code Qualifier (2010A-NM1-08) field, select the code qualifier.

3. In the Identification Code (2010A-NM1-09) field, enter the code.

4. Click the View Health Care Services Review (278) Defaults button to view a report of the current defaults.

• Multiple entries can be filed for funding source and benefit plan combinations:

5. In the Funding Source field, select the funding source.

6. In the Default Benefit Plan field, select the benefit plan.

7. In the Add/Edit or Delete field, select Delete to delete the funding source.

8. Click Update Funding Source.