ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X342
Business Scenario - Admission surgical request with px code
A Provider submits an initial elective surgical admission request for a surgical service that includes a procedure code using the X342 8010 version.
Inbound Transmission Explanation
ST*278*1001*008010X342~
Submitter transaction identifier
BHT*0007*13*16139462398*20200624*0734~
HL*1**20*1~
Payer Loop
NM1*X3*2*PAYOR A*****PI*1234567~
HL*2*1*21*1~
Requesting Entity Loop
NM1*1P*1*PROVIDER*ADMITTING****XX*1234567899~
Requesting Entity
PER*IC*CONTACT NAME*TE*5556368147*EX*551~
Contact Name and other information
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
TRN*1*16139462398*3030240928~
Event Level TRN
UM*AR*I*2*21:B**E~
Admission, Initial, Surgical, IP Hospital, Elective
DTP*435*D8*20200702~
Admission Date=7/2/20
HI*ABJ:C189~
Admitting Diagnosis
HSD*DY*1~
Length of Stay
MSG*ADDITIONAL INFORMATION CAN BE PROVIDED IN MSG~
Additional information
NM1*71*1*PROVIDER*ATTENDING****XX*1234567898~
NM1*DO*1*PROVIDER*ADMITTING****XX*1234567899~
Event Provider role identification
NM1*FA*2*FACILITY NAME*****XX*1234567888~
HL*5*4*SS*0~
Service Loop
DTP*472*D8*20200702~
SV2**HC:44205~
HSD*FL*1~
PX code= 44205 to be completed x1 on 7/2/20
SE*25*1001~
Outbound Transmission Explanation
ST*278*0001*008010X342~
Submitter transaction identifier from request
BHT*0007*11*16139462398*20200624*07344807*18~
HL*1**20*1~
Payer Loop
NM1*X3*2*PAYOR A*****PI*1234567~
HL*2*1*21*1~
Requesting Entity Loop
NM1*1P*1*PROVIDER*ADMITTING****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*1~
Event Loop
TRN*2*16139462398*3030240928~
Service Trace Number
UM*AR*I**21:B**E~
Admission, Initial, Inpatient Hospital, Elective
HCR*A1*5554772110000000~
Certification Action Code, Review ID number
DTP*435*D8*20200702~
Admission Date=7/2/20
HI*ABJ:C189~
Admitting Diagnosis
NM1*71*1*PROVIDER*ATTENDING****XX*1234567898~
NM1*DO*1*PROVIDER*ADMITTING****XX*1234567899~
Event Provider role identification
NM1*FA*2*FACIITY NAME*****XX*1234567888~
HL*5*4*SS*0~
Service Loop
UM*HS*I*2~
Service Type=Surgical
HCR*A1*5554772110000000~
Certification Action Code, Review ID number
DTP*472*RD8*20200702-20200702~
Surgical Service to be completed on 7/2/20
HL*6*4*SS*0~
Service Loop
UM*HS*I~
HCR*A1*5554772110000000~
Certification Action Code, Review ID number
DTP*472*RD8*20200702-20200702~
SV2**HC:44205~
HSD*FL*1~
PX code= 44205 to be completed x1 on 7/2/20
SE*29*0001~