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Health Care Services Review - 278 Authorization Request/Response Section - PM

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Define the standards for the Health Care Services Review (278) Transaction Set.

ISA Segment Elements

  1. In the Authorization Information Qualifier (ISA-01) field, select the authorization qualifier.
  2. In the Authorization Information (ISA-02) field, enter the 10-character authorization value.
  3. In the Security Information Qualifier (ISA-03) field, select the security qualifier.
  4. In the Security Information (ISA-04) field, enter the 10-character security value, or password.
  5. In the Interchange Sender ID Qualifier (ISA-05) field, select the sender qualifier.
  6. In the Interchange Sender ID (ISA-06) field, enter the 15-character value to identify the sender.
  7. In the Interchange Receiver ID Qualifier (ISA-07) field, select the receiver qualifier.
  8. In the Interchange Receiver ID (ISA-08) field, enter the 15-character value to identify the receiver.
  9. In the Repetition Separator (ISA-11) field, enter a character to use as a separator between segments.
  10. In the Acknowledgment Requested (ISA-14) field, select whether or not there is an acknowledgement requested.
  11. In the Usage Indicator (ISA-15) field, select whether is data is for test or production.

GS Segment Elements

  1. In the Application Sender's Code (GS-02) field, enter the code for the sender.
  2. In the Application Receiver's Code (GS-03) field, enter the code for the receiver.

Utilization Management

  1. In the Utilization Management Entity Type Code field, select the type of entity.
  2. In the Utilization Management Entity Type Qualifier field, select whether or not the entity type is a person.
  3. In the Utilization Management Organization Last Name or Organization Name field, enter the organization name.
    If a person, enter the last name here and the first name in the Utilization Management Organization First Name field.
  4. In the Utilization Management Organization ID Code Qualifier field, select the qualifier.
  5. In the Utilization Management Organization ID Code field, enter the value for the qualifier.

Requester Data

  1. In the Requester Entity Type Code field, select the type of entity for the requester.
  2. In the Requester Entity Type Qualifier field, select whether or not the entity type is a person.
  3. In the Requester Last Name or Organization Name field, enter the organization name.
    If a person, enter the last name here and the first name in the Requester First Name field.
  4. In the Requester ID Code Qualifier field, select the requester qualifier.
  5. In the Requester ID Code field, enter the value for the requester qualifier.
  6. In the Requester Supplemental ID Code Qualifier field, select the supplemental requester qualifier.
  7. In the Requester Supplemental ID field, enter the value for the supplemental requester qualifier.
  8. In the 'Requester Address' fields, enter the address information for the requester.
► Registry Setting
► SQL Table
  • SYSTEM.table_278_fac_prov_num