The Health Care Services Review Inquiry and Response Implementation Guide (007030X327) 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 (007030X328) 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 (007030X342) 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
These implementation guides were developed by X12's Insurance Subcommittee and were recently the subject of public review. The public review comments and associated work group responses will be reviewed at the informational forum. This is the final opportunity for public discussion of the comments and any resulting revisions.
The draft revisions, submitted comments, and associated responses are available at http://forums.x12.org until the conclusion of the informational forum. The draft is provided for public review and cannot be used for any other purpose without permission from X12. Responses to all comments will be posted no later than fifteen (15) days prior to the informational forum.
Individuals who will not be onsite at the Standing Meeting may participate in this informational forum virtually. To participate virtually, register for the Standing Meeting here by January 9, 2019.
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