Section title: X12 EDI Examples
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ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X327

Business Scenario - Inquiry request with single event returned

A Provider submits an Inquiry request to view a member’s unique event using the X327 8010 version.

Inbound Transmission Explanation

ST*278*0001*008010X327~

Submitter transaction identifier

BHT*0007*28*202009141318220*20200914*141822~

HL*1**20*1~

Payer Loop

NM1*PR*2*AETNA*****PI*042064683~

HL*2*1*21*1~

Requesting Entity Loop

NM1*1P*1*PCPLASTNAME*PCPFIRSTNAME****XX*1234567899~

Requesting Entity

HL*3*2*22*1~

Subscriber Loop

NM1*IL*1*LASTNAME*FIRSTNAME****MI*MEMBERID~

Member Data

DMG*D8*19470701*M~

HL*4*3*EV*0~

Event Loop

UM*HS~

REF*NT*7725714110000000~

Previous Administrative Reference Number

SE*13*0001~

Outbound Transmission Explanation

ST*278*0001*008010X327~

BHT*0007*49*202009141318220*20200914*14182425*RD~

HL*1**20*1~

Payer Loop

NM1*X3*2*AETNA*****PI*953402799~

HL*2*1*21*1~

Requesting Entity Loop

NM1*1P*2*ADVOCATE GOOD SAMARITAN HOSPITAL*****XX*1578670543~

Requesting Entity

HL*3*2*22*1~

Subscriber Loop

NM1*IL*1*LASTNAME*FIRSTNAME****MI*MEMBERID~

Member Data

DMG*D8*19470701*M~

HL*4*3*EV*1~

Event Loop

UM*HS*I**22:B~

Health Services*Initial*OP Hospital

HCR*A2*7725714110000000~

Certification Action Code, Review ID number

HI*ABF:M24151~

Diagnosis

MSG*AWAITNG CLINCIAL DOCMENTATION TO COMPLETE REVIEW~

Additional Information returned

NM1*71*1*PROVIDER*ATTENDING****XX*1234567898~

NM1*FA*2*FACILITY NAME*****XX*1234567888~

Event Provider role identification

HL*5*4*SS*0~

Service Loop

HCR*A1*7725714110000000~

Certification Action Code, Review ID number

DTP*472*D8*20201005~

SV1*HC:29914~

PX code = 29914 to begin on x1 on 10/05/2020

HSD*FL*1~

HL*6*4*SS*0~

Service Loop

HCR*A3*7725714110000000*0N~

Certification Action Code, Review ID number

DTP*472*D8*20201005~

SV1*HC:29916~

PX code = 29916 was to begin on x1 on 10/05/2020

HSD*FL*1~

SE*27*0001~