Announcing a Public Review for the 278 Health Care Services Review Inquiry/Response (007030X327), Health Care Services Review Notification (007030X328), and Health Care Services Request for Review and Response (007030X342)

X12 will conduct a public review related to the above implementation guides will be available for public review beginning December 16, 2019. The review period will close January 15, 2020 at 8:00 PM, Eastern Time. The focus of this public review is the 2000F HI segment (Additional Service Description), which was modified based on comments received during the previous comment period.

12/16/2019

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

The draft implementation guide will be available in an on-line forum 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 draft 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 forum during the public review period and prior to the Informational Forum. Watch for the announcement of the corresponding Informational Forum.

Questions may be directed to info@x12.org.