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

2 - Health Services Review

The term "health services review" identifies a notification of authorization for specific treatments or more extended care. Extended care refers to treatment for a condition requiring prolonged rehabilitation therapy. This transaction set supports a notification for authorization of services related to specific treatment or extended care associated with a single patient event. Complex treatment plans represent multiple patient events. Use a separate notification transaction for each patient event.

This is an example of a notification indicating a certified in total decision for chiropractic services of the spine. The UMO is notifying the chiropractor that it has authorized 24 visits to occur twice per week over a (3) month period.

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.