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

3 - Admission Review

The term "admission review" identifies a notification of authorization for admission to a facility for treatment (pre-certification). The transaction set enables the notification sender to specify both the admission to the facility and the associated inpatient procedures authorized within the same transaction. In this scenario, the specialist requested authorization to admit the patient for a surgical procedure. The UMO has authorized the request and sends a notification of the authorization to the facility. The notification contains one occurrence of Loop 2000E, one occurrence of Loop 2010EA, one occurrence of Loop 2000F and one occurrence of Loop 2010F:

Loop 2000E (Service Provider - Facility)
Loop 2000F (Admission Review)
Loop 2000E (Service Provider - Operating Surgeon)
Loop 2000F (Health Services Review for surgical procedure)

The following example demonstrates a notification of authorization for the facility portion of an admission review.

Transmission Explanation


The UM segment identifies the type of health care services.

UM01 = AR (Admission Review)
UM02 = I (Initial Request)
UM03 = 2 (Surgical)
UM04 = 21:B (Hospital - inpatient)

The DTP segment carries the anticipated date range of the admission and the CL1 value indicates the priority of the admission.