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278 Authorization Request/Response Section - PM

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Define the standards for the Health Care Services Review (278) Transaction Set.
  1. In the Enable 278 Request/Response Transaction field, select:
    • No - disables the remaining fields and prevents this guarantor from being used for 278 requests.
    • Yes - means that when entering a managed care authorization for this guarantor, the authorization can be flagged to be included in the 278 Request transmission.
    • Yes-Restrict Manual Authorizations - means that when entering a managed care authorization for this guarantor, users can only enter Authorization Requests. All approvals must come from the 278 Responses. You will not be able to select Approved for Authorization Status in the Managed Care Authorizations form.
  2. In the Create Single File Per Interchange Control Header field, select whether or not to create a new file per ISA when creating the 278 submission file.
  3. In the If The ISA Segment Information For A Particular Guarantor Is The Same For All Program Combination(s)... field, select whether or not to combine the ISA segments in the 278 submission file for each matching ISA.
  4. In the If The GS Segment Information For A Particular Guarantor Is The Same For All Program Combination(s)... field, select whether or not to combine the GS segments in the 278 submission file for each matching GS.
  5. In the If Creating A Single GS Segment For A Particular Guarantor... field, select whether or not to combine the ST segments in the 278 submission file for each matching ST.
  6. In the Unique Interchange Control Number (ISA-13) For All Submissions field, select whether or not to use a Unique Interchange Control Number for each 278 submission.
  7. In the Current Interchange Control Number (ISA-13) field, enter the current number used for ISA-13.
  8. In the Unique Group Control Number (GS-06) For All Submissions field, select whether or not to use a Unique Group Control Number for each 278 submission.
  9. In the Current Group Control Number (GS-06) field, enter the current number used for GS-06.
  10. In the Unique Transaction Set Control Number (ST-02) For All Submissions field, select whether or not to use a Unique Transaction Set Control Number for each 278 submission.
  11. In the Current Traction Set Control Number (ST-02) field, enter the current number used for ST-02.
  12. In the Unique Originator Application Transaction Identifier (BHT-03) For All Submissions field, select whether or not to use a Unique Application Transaction Identifier for each 278 submission.
  13. In the Current Originator Application Transaction Identifier (BHT-03) field, enter the current number used for BHT-03.

SQL Table

  • SYSTEM.billing_guar_table_278