Section title: X12 EDI Examples
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ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X342

Business Scenario - Outpatient Hospital request with multiple px codes

A Provider submits an initial Outpatient Hospital request with multiple procedure codes using the X342 8010 version.

Inbound Transmission Explanation

ST*278*1001*008010X342~

Submitter transaction Identifier

BHT*0007*13*16139462398*20200624*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*ATTENDING****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*M~

HL*4*3*EV*1~

Event Loop

UM*HS*I**22:B**E~

Health Services, Initial, OP Hospital, Elective

DTP*AAH*D8*20200702~

Event Date=7/2/20

HI*ABF:C189~

Diagnosis

MSG*ADDITIONAL INFORMATION CAN BE PROVIDED IN MSG~

Additional information

NM1*71*1*PROVIDER*ATTENDING****XX*1234567899~

Event Provider role identification

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

HL*5*4*SS*0~

Service Loop

SV2**HC:30420~

PX code = 30420 to be completed x1 on 7/2/20

HSD*FL*1~

HL*6*4*SS*0~

Service Loop

SV2**HC:30124~

PX code = 30124 to be completed x1 on 7/2/20

HSD*FL*1~

SE*24*1001~

Outbound Transmission Explanation

ST*278*0001*008010X342~

Submitter transaction Identifier from request

BHT*0007*11*16139462398*20200624*07344807*19~

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*ATTENDING****XX*1234567899~

Requesting Entity

HL*3*2*22*1~

Subscriber Loop

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

Member Data

DMG*D8*19470701*M~

HL*4*3*EV*1~

Event Loop

UM*HS*I**22:B**E~

Health Services*Initial*OP Hospital* Elective

HCR*A4**0V~

Certification Action Code

REF*NT*5554772110000000~

Administrative Reference #

DTP*AAH*D8*20200702~

Event Date=7/2/20

HI*ABF:C189~

Diagnosis

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

Event Provider role identification

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

HL*5*4*SS*0~

Service Loop

UM*HS*I~

HCR*A4**0V~

Certification Action Code

REF*NT*5554772110000000~

Administrative Reference Number

DTP*472*RD8*20200702-20200702~

SV2**HC:30420~

PX code= 30420 to begin on x1 on 7/2/20

HSD*FL*1~

HL*6*4*SS*0~

Service Loop

UM*HS*I~

HCR*A4**0V~

Certification Action Code

REF*NT*5554772110000000~

Administrative Reference Number

DTP*472*RD8*20200702-20210202~

SV2**HC:30124~

PX code = 30124 to begin on x1 on 7/2/20

HSD*FL*1~

SE*32*0001~