HCR01 Action Codes (278 Response)

HCR01 — Action Code (X12 element 1371)

HCR (Health Care Services Review), 278 response · 278 Health Care Services Review — Response (005010X217)

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Code	Name	Summary
A1	Certified in Total	The review is complete and everything requested is certified — the full approval outcome.
A2	Certified - Partial	Part of what was requested is certified, part is not — for example, fewer visits, fewer days, or a different level of care than requested.
A3	Not Certified	The request is denied — an adverse determination.
A4	Pended	No determination yet — the request is pended, most often for additional clinical information or medical review.
A6	Modified	The certification is modified relative to what was requested or previously certified — different dates, provider, service details, or quantities.
C	Cancelled	The certification is cancelled — typically the response to a cancellation request (UM02 = 3), confirming the previously issued certification is void.
CT	Contact Payer	The request cannot be resolved through the electronic transaction — the submitter must contact the payer (or UM organization) directly.
NA	No Action Required	No review action is required — commonly the answer when the service does not require prior authorization for this member, or the notification is accepted without a certification decision.