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

4 - Revisions

To revise a specific procedure code that was previously approved, UM02 in Loop 2000E will equal S (Revised) and the authorization number being revised will appear in the REF Previous Review Authorization Number if the authorization was granted at the Event Level. In the 2000F loop, UM02 will equal 3 (Cancel) in the first iteration of the service loop and the procedure code that is being changed from the original request is reported. If the authorization was granted at the Service Level, the previous review authorization number is reported in the REF Previous Review Authorization Number in Loop 2000F. In a second iteration of the 2000F loop, the new procedure code is reported. UM02 will equal S (Revised) to indicate that this loop will contain the revised procedure.

Transmission Explanation

2000E Loop

UM*SC*S*3~
REF*BB*20111109ABCD~

First iteration of 2000F Loop

UM*SC*3~
SV1*HC:99211~

Second iteration of 2000F Loop

UM*SC*S~
SV1*HC:99212~

The response will acknowledge the cancellation of the old procedure and the action on the new procedure.