Section title: X12 EDI Examples
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ASC X12 Version: 005010 | Transaction Set: 278 | TR3 ID: 005010X217

Example 3: Request for Behavioral Health Emergency Admission

This is an example of admission for behavioral health care. Mary Smith is a subscriber to the Capital Insurance Company and presents at the General Hospital emergency room. Dr. Marcus Jones, the attending physician, evaluates Mary and decides to admit Mary to the Inpatient Psychiatric unit at General Hospital. The preliminary diagnosis is 296.03, Bipolar I Disorder, Single Manic Episode, Severe without Psychotic Features. Dr. Jones recommends 3 days of inpatient treatment, under the care of Dr. Jacob Brown. The registration clerk determines that Capital Insurance requires pre-certification of care and submits a request for an admission to the hospital.