Prior Authorization/Referral Standard v3

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Health Care Services Review - Request for Review and Response (278)

UHIN Prior Authorization/Referral Standard is compatible with all HIPAA requirements.

Purpose: The purpose of this Standard is to lay out general recommendations to payers and providers about handling electronic prior authorization/referral (termed the 278).

Applicability: This Standard applies to all electronically submitted prior authorizations and referrals in the state of Utah after January 1, 2012.  The Standard may be adopted voluntarily prior to that date.

Detail:

  1. Standard Prior Authorization and Referral Transaction:

The UHIN Standard for electronic prior authorizations and referrals is the HIPAA ASC X12 005010X217 Health Care Services Review – Request for Review and Response (278) Technical Report Type 3 (TR3) and any applicable Addenda and Errata.

See the Washington Publishing Company web site (http://www.wpc-edi.com) to purchase the TR3.

  1. The 2010B PER segment containing Contact Information is required in any 278 Request for Review submission.

 

 

Original

A1

V3.0

 

 

ORIGINATION DATE

3/23/2001

 

11/30/2010

 

 

APPROVAL DATE

4/11/2001

9/9/2002

5/18/2011

 

 

EFFECTIVE DATE

5/11/2001

10/9/2002

6/18/2011

 

 

 

 

Click below to download a copy of this document. 

 

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