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This document provides instructions for trading partners on how to submit prior authorization requests for Medicaid services using the ASC X12N 278 v5010 format, including testing requirements and

How to fill out 278 authorization request

How to fill out 278 Authorization Request

1. Obtain the correct 278 Authorization Request form from the appropriate source.
2. Fill in patient information, including name, date of birth, and insurance details.
3. Provide information about the healthcare provider, including name, NPI number, and contact information.
4. Specify the requested services, including procedure codes, dates of service, and descriptions.
5. Include any necessary clinical information or supporting documentation to justify the request.
6. Indicate the reason for the referral or authorization clearly.
7. Review the form for completeness and accuracy before submission.
8. Submit the completed form to the appropriate payer or insurance company.

Who needs 278 Authorization Request?

1. Healthcare providers requesting pre-authorization for specific medical services.
2. Patients who require medical care that necessitates prior approval from their insurance.
3. Insurance companies that need to evaluate requests for coverage before approving services.

People Also Ask about

What is healthcare service review information 278?

A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from a payer, such as an insurance company. The hospital is asking the insurance company to review proposed healthcare services to be provided to a given patient, in order to obtain an authorization for these services.

What is 278I?

EDI 278I is the transaction used to check the status of previously submitted authorizations and notifications. Back to Glossary.

What is a 277 file in healthcare?

The EDI 277 transaction is an electronic Healthcare Claim Status Notification (also known as ANSI X12 EDI 277). An EDI 277 Healthcare Claim Status Notification is sent by the healthcare insurance company/payor to report on the status of claims that were previously submitted by healthcare providers.

What is the 278 response code?

The 278 Response identifies those requests that were unsuccessful. Data from inquiries that are rejected with a TA1 or 999 Transaction are retained for 90 days from the date of receipt. The 278 HIPAA Implementation Guide does not have a restriction on the number of patient reviews allowed within a batch.

What is a 278 transaction in healthcare?

A healthcare provider, such as a hospital, will send a 278 transaction to request an authorization from a payer, such as an insurance company. The hospital is asking the insurance company to review proposed healthcare services to be provided to a given patient, in order to obtain an authorization for these services.

What is the 278 response code?

The 278 Response identifies those requests that were unsuccessful. Data from inquiries that are rejected with a TA1 or 999 Transaction are retained for 90 days from the date of receipt. The 278 HIPAA Implementation Guide does not have a restriction on the number of patient reviews allowed within a batch.

For pdfFiller’s FAQs

What is 278 Authorization Request?

The 278 Authorization Request is a standardized electronic request used in the healthcare industry, primarily to obtain prior authorization for non-emergency medical services and procedures.

Who is required to file 278 Authorization Request?

Healthcare providers, such as physicians and medical facilities, are typically required to file the 278 Authorization Request when seeking approval from health insurers for specific services or treatments.

How to fill out 278 Authorization Request?

To fill out a 278 Authorization Request, providers must complete the electronic form with pertinent information including patient details, proposed services, relevant diagnosis codes, and other necessary clinical information to justify the service.

What is the purpose of 278 Authorization Request?

The purpose of the 278 Authorization Request is to streamline the process of obtaining authorization from payers for medical services, ensuring that treatments are covered under a patient's insurance plan before they are provided.

What information must be reported on 278 Authorization Request?

The 278 Authorization Request must report information such as patient identifiers, service codes, procedure descriptions, diagnosis codes, provider information, and any clinical notes that support the medical necessity of the requested services.