Section title: X12 EDI Examples
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ASC X12 Version: 008030 | Transaction Set: 278 | TR3 ID: 008030X328

1 - Specialty Referral

Specialty care referral notifications encompass those transactions where a provider requests or grants permission to refer or send a patient to another provider, generally a specialist. These types of transactions generally are shared between a primary care physician and a UMO. However, they may just as easily be shared between any two providers or UMOs. The following example contains a notification of authorization for an initial service consisting of a single office visit for a consultation at the provider's office.

Transmission Explanation


The UM segment is used to identify the type of health care services.

UM01 = HS (Health Services Review)
UM02 = I (Initial Request)
UM03 = 33 (Chiropractic)

The HSD Segment specifies the pattern of delivery for the requested services. The request for spinal manipulation services will include 2 visits per week over a 3 month period.