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 = SC (Specialty Care Review)
UM02 = I (Initial Request)
UM03 = 3 (Consultation)
UM04 = 11:B (Physician's Office)

The HCR segment provides the results of the review as well as a review identification number. This set of values indicates approval of the request in full. A review identification number of 0081096G is supplied and is critical if the notification sender wishes to initiate further transactions concerning this service.

The HSD segment identifies the number of visits authorized.