Announcing Public Review Periods for 3 Draft Implementation Guides

The following three implementation guides are available for public review beginning September 1, 2017. Each review period will close November 30, 2017 at 8:00 PM, Eastern Time. These guides have been developed by X12's Insurance subcommittee based on version 007030 of the X12 Standard.

  • The Health Care Services Review Inquiry/Response 278 (007030X327)
  • The Health Care Services Review – Notification 278 (007030X328)
  • The Health Care Services Request for Review and Response 278 (007030X342)

The Health Care Services Review Inquiry and Response Implementation Guide describes the use of the 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

The Health Care Services Review - Notification Implementation Guide describes the use of the X12 Health Care Services Review Information (278) transaction set for the following business usage: Notification of interested parties concerning events related to a health care services review such as:

  • Patient arrival notice
  • Patient discharge notice
  • Patient transfer notice
  • Notification of certification to primary care physician (PCP), utilization management organization (UMO), or other service providers
  • Certification notice change

The Health Care Services Review Request and Response Implementation Guide describes the use of the X12 Health Care Services Review Information (278) transaction set for the following business usages:

  • Health care admission certificate requests and responses
  • Referral requests and responses
  • Health care services certification requests and responses
  • Extend certification requests and responses
  • Certification appeal requests and responses

The draft implementation guides are available in on-line forums at http://forums.x12.org. The draft information is provided for public review and cannot be used for any other purpose without permission from X12. Reviewers may submit comments on the drafts via the on-line forum. Instructions for reviewing the pages and submitting comments are posted on the forums page.

Interested parties may monitor all submitted comments and the associated responses via the on-line forums during the public review period and prior to the Informational Forums. To continue participating in our public review process, watch for the announcement of the corresponding Informational Forums.

Questions may be directed to info@x12.org.