Section title: X12 EDI Examples
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X12 Version: 008060 | Transaction Set: 278 | TR3 ID: 008060X342

Business Scenario - Admission surgical request with px code

A Provider submits an initial elective surgical admission request for a surgical service that includes a procedure code using the X342 8060 version.

Inbound Transmission Explanation

ST*278*1001*008060X342~

Submitter transaction identifier

BHT*0007*13*16139462398*20240624*0734~

HL*1**20*1~

Payer Loop

NM1*X3*2*PAYOR A*****PI*1234567~

HL*2*1*21*1~

Requesting Entity Loop

NM1*1P*1*PROVIDER*ADMITTING****XX*1234567899~

Requesting Entity

PER*IC*CONTACT NAME*TE*5556368147*EX*551~

Contact Name and other information

HL*3*2*22*1~

Subscriber Loop

NM1*IL*1*LASTNAME*FIRSTNAME****MI*MEMBERID~

Member Data

DMG*D8*19470701~

DMH*M~

HL*4*3*EV*1~

Event Loop

TRN*1*16139462398*3030240928~

Event Level TRN

UM*AR*I*2*21:B**E~

Admission, Initial, Surgical, IP Hospital, Elective

DTP*435*D8*20240702~

Admission Date=7/2/24

HI*ABJ:C189~

Admitting Diagnosis

HSD*DY*1~

Length of Stay

MSG*ADDITIONAL INFORMATION CAN BE PROVIDED IN MSG~

Additional information

NM1*71*1*PROVIDER*ATTENDING****XX*1234567898~

NM1*DO*1*PROVIDER*ADMITTING****XX*1234567899~

Event Provider role identification

NM1*FA*2*FACILITY NAME*****XX*1234567888~

HL*5*4*SS*0~

Service Loop

DTP*472*D8*20240702~

SV2**HC:44205~

PX code= 44205 to be completed x1 on 7/2/24

HSD*FL*1~

SE*26*1001~

Outbound Transmission Explanation

ST*278*0001*008060X342~

Submitter transaction identifier from request

BHT*0007*11*16139462398*20240624*07344807*18~

HL*1**20*1~

Payer Loop

NM1*X3*2*PAYOR A*****PI*1234567~

HL*2*1*21*1~

Requesting Entity Loop

NM1*1P*1*PROVIDER*ADMITTING****XX*1234567899~

Requesting Entity

HL*3*2*22*1~

Subscriber Loop

NM1*IL*1*LASTNAME*FIRSTNAME****MI*MEMBERID~

Member Data

DMG*D8*19470701~

DMH*M~

HL*4*3*EV*1~

Event Loop

TRN*2*16139462398*3030240928~

Service Trace Number

UM*AR*I**21:B**E~

Admission, Initial, Inpatient Hospital, Elective

HCR*A1*5554772110000000~

Certification Action Code, Review ID number

DTP*435*D8*20240702~

Admission Date=7/2/24

HI*ABJ:C189~

Admitting Diagnosis

NM1*71*1*PROVIDER*ATTENDING****XX*1234567898~

NM1*DO*1*PROVIDER*ADMITTING****XX*1234567899~

Event Provider role identification

NM1*FA*2*FACILITY NAME*****XX*1234567888~

HL*5*4*SS*0~

Service Loop

UM*HS*I*2~

Service Type=Surgical

HCR*A1*5554772110000000~

Certification Action Code, Review ID number

DTP*472*RD8*20240702-20240702~

Surgical Service to be completed on 7/2/24

HL*6*4*SS*0~

Service Loop

UM*HS*I~

HCR*A1*5554772110000000~

Certification Action Code, Review ID number

DTP*472*RD8*20240702-20240702~

SV2**HC:44205~

PX code= 44205 to be completed x1 on 7/2/24

HSD*FL*1~

SE*30*0001~