Standards & EDI
X12 278
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
The 278 carries who is asking (requester), who is being asked (UMO), the patient, the event or services under review (UM segment), and in responses the determination (HCR segment) or validation problems (AAA segments). HHS has said it will exercise enforcement discretion over the 278 requirement when both parties use an end-to-end FHIR prior authorization workflow.