X12 278 prior authorization: format and example

278 structure

The full X12 278 layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 44 loops and 313 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.

Segment / loop	Name	Usage	Max use
`ST`	Transaction Set Header	Required	1
Loop BHT	Beginning of Hierarchical Transaction	Situational	1
`BHT`	Beginning of Hierarchical Transaction	Situational	1
Loop 2000A	Utilization Management Organization UMO Level	Situational	1
`HL`	Utilization Management Organization UMO Level	Required	1
Loop 2010A	Utilization Management Organization UMO Name	Required	1
`NM1`	Utilization Management Organization UMO Name	Required	1
Loop 2000B	Requester Level	Required	1
`HL`	Requester Level	Required	1
Loop 2010B	Requester Name	Required	1
`NM1`	Requester Name	Required	1
`REF`	Requester Supplemental Identification	Situational	8
`N3`	Requester Address	Situational	1
`N4`	Requester City State ZIP Code	Situational	1
`PER`	Requester Contact Information	Situational	1
`PRV`	Requester Provider Information	Situational	1
Loop 2000C	Subscriber Level	Required	1
`HL`	Subscriber Level	Required	1
Loop 2010C	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`REF`	Subscriber Supplemental Identification	Situational	9
`N3`	Subscriber Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`DMG`	Subscriber Demographic Information	Situational	1
`INS`	Subscriber Relationship	Situational	1
Loop 2000D	Dependent Level	Situational	1
`HL`	Dependent Level	Required	1
Loop 2010D	Dependent Name	Required	1
`NM1`	Dependent Name	Required	1
`REF`	Dependent Supplemental Identification	Situational	3
`N3`	Dependent Address	Situational	1
`N4`	Dependent City State ZIP Code	Situational	1
`DMG`	Dependent Demographic Information	Situational	1
`INS`	Dependent Relationship	Situational	1
Loop 2000E	Patient Event Level	Required	1
`HL`	Patient Event Level	Required	1
`TRN`	Patient Event Tracking Number	Situational	2
`UM`	Health Care Services Review Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
`REF`	Previous Review Administrative Reference Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Accident Date	Situational	1
`DTP`	Last Menstrual Period Date	Situational	1
`DTP`	Estimated Dateof Birth	Situational	1
`DTP`	Onsetof Current Symptomsor Illness Date	Situational	1
`DTP`	Event Date	Situational	1
`DTP`	Admission Date	Situational	1
`DTP`	Discharge Date	Situational	1
`HI`	Patient Diagnosis	Situational	1
`HSD`	Health Care Services Delivery	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification Information	Situational	1
`CRC`	Chiropractic Certification Information	Situational	1
`CRC`	Durable Medical Equipment Information	Situational	1
`CRC`	Oxygen Therapy Certification Information	Situational	1
`CRC`	Functional Limitations Information	Situational	1
`CRC`	Activities Permitted Information	Situational	1
`CRC`	Mental Status Information	Situational	1
`CL1`	Institutional Claim Code	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
`CR5`	Home Oxygen Therapy Information	Situational	1
`CR6`	Home Health Care Information	Situational	1
`PWK`	Additional Patient Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010EA	Patient Event Provider Name	Situational	14
`NM1`	Patient Event Provider Name	Required	1
`REF`	Patient Event Provider Supplemental Information	Situational	7
`N3`	Patient Event Provider Address	Situational	1
`N4`	Patient Event Provider City State Zip Code	Situational	1
`PER`	Patient Event Provider Contact Information	Situational	1
`PRV`	Patient Event Provider Information	Situational	1
Loop 2010EB	Patient Event Transport Information	Situational	5
`NM1`	Patient Event Transport Information	Required	1
`N3`	Patient Event Transport Location Address	Required	1
`N4`	Patient Event Transport Location City State ZIP Code	Required	1
Loop 2010EC	Patient Event Other UMO Name	Situational	3
`NM1`	Patient Event Other UMO Name	Required	1
`REF`	Other UMO Denial Reason	Required	1
`DTP`	Other UMO Denial Date	Required	1
Loop 2000F	Service Level	Situational	>1
`HL`	Service Level	Required	1
`TRN`	Service Trace Number	Situational	2
`UM`	Health Care Services Review Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
`REF`	Previous Review Administrative Reference Number	Situational	1
`DTP`	Service Date	Situational	1
`SV1`	Professional Service	Situational	1
`SV2`	Institutional Service Line	Situational	1
`SV3`	Dental Service	Situational	1
`TOO`	Tooth Information	Situational	32
`HSD`	Health Care Services Delivery	Situational	1
`PWK`	Additional Service Information	Situational	10
`MSG`	Message Text	Situational	1
Loop 2010F	Service Provider Name	Situational	10
`NM1`	Service Provider Name	Required	1
`REF`	Service Provider Supplemental Identification	Situational	8
`N3`	Service Provider Address	Situational	1
`N4`	Service Provider City State ZIP Code	Situational	1
`PER`	Service Provider Contact Information	Situational	1
`PRV`	Service Provider Information	Situational	1
Loop 2000E	Patient Event Level	Situational	1
`HL`	Patient Event Level	Required	1
`TRN`	Patient Event Tracking Number	Situational	2
`UM`	Health Care Services Review Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
`REF`	Previous Review Administrative Reference Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Accident Date	Situational	1
`DTP`	Last Menstrual Period Date	Situational	1
`DTP`	Estimated Dateof Birth	Situational	1
`DTP`	Onsetof Current Symptomsor Illness Date	Situational	1
`DTP`	Event Date	Situational	1
`DTP`	Admission Date	Situational	1
`DTP`	Discharge Date	Situational	1
`HI`	Patient Diagnosis	Situational	1
`HSD`	Health Care Services Delivery	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification Information	Situational	1
`CRC`	Chiropractic Certification Information	Situational	1
`CRC`	Durable Medical Equipment Information	Situational	1
`CRC`	Oxygen Therapy Certification Information	Situational	1
`CRC`	Functional Limitations Information	Situational	1
`CRC`	Activities Permitted Information	Situational	1
`CRC`	Mental Status Information	Situational	1
`CL1`	Institutional Claim Code	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
`CR5`	Home Oxygen Therapy Information	Situational	1
`CR6`	Home Health Care Information	Situational	1
`PWK`	Additional Patient Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010EA	Patient Event Provider Name	Situational	14
`NM1`	Patient Event Provider Name	Required	1
`REF`	Patient Event Provider Supplemental Information	Situational	7
`N3`	Patient Event Provider Address	Situational	1
`N4`	Patient Event Provider City State Zip Code	Situational	1
`PER`	Patient Event Provider Contact Information	Situational	1
`PRV`	Patient Event Provider Information	Situational	1
Loop 2010EB	Patient Event Transport Information	Situational	5
`NM1`	Patient Event Transport Information	Required	1
`N3`	Patient Event Transport Location Address	Required	1
`N4`	Patient Event Transport Location City State ZIP Code	Required	1
Loop 2010EC	Patient Event Other UMO Name	Situational	3
`NM1`	Patient Event Other UMO Name	Required	1
`REF`	Other UMO Denial Reason	Required	1
`DTP`	Other UMO Denial Date	Required	1
Loop 2000F	Service Level	Situational	>1
`HL`	Service Level	Required	1
`TRN`	Service Trace Number	Situational	2
`UM`	Health Care Services Review Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
`REF`	Previous Review Administrative Reference Number	Situational	1
`DTP`	Service Date	Situational	1
`SV1`	Professional Service	Situational	1
`SV2`	Institutional Service Line	Situational	1
`SV3`	Dental Service	Situational	1
`TOO`	Tooth Information	Situational	32
`HSD`	Health Care Services Delivery	Situational	1
`PWK`	Additional Service Information	Situational	10
`MSG`	Message Text	Situational	1
Loop 2010F	Service Provider Name	Situational	10
`NM1`	Service Provider Name	Required	1
`REF`	Service Provider Supplemental Identification	Situational	8
`N3`	Service Provider Address	Situational	1
`N4`	Service Provider City State ZIP Code	Situational	1
`PER`	Service Provider Contact Information	Situational	1
`PRV`	Service Provider Information	Situational	1
Loop BHT	Beginning of Hierarchical Transaction	Situational	1
`BHT`	Beginning of Hierarchical Transaction	Situational	1
Loop 2000A	Utilization Management Organization UMO Level	Situational	1
`HL`	Utilization Management Organization UMO Level	Required	1
`AAA`	Request Validation	Situational	9
Loop 2010A	Utilization Management Organization UMO Name	Required	1
`NM1`	Utilization Management Organization UMO Name	Required	1
`PER`	Utilization Management Organization UMO Contact Information	Situational	1
`AAA`	Utilization Management Organization UMO Request Validation	Situational	9
Loop 2000B	Requester Level	Situational	1
`HL`	Requester Level	Required	1
Loop 2010B	Requester Name	Required	2
`NM1`	Requester Name	Required	1
`REF`	Requester Supplemental Identification	Situational	8
`AAA`	Requester Request Validation	Situational	9
`PRV`	Requester Provider Information	Situational	1
Loop 2000C	Subscriber Level	Situational	1
`HL`	Subscriber Level	Required	1
Loop 2010C	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`REF`	Subscriber Supplemental Identification	Situational	9
`N3`	Subscriber Mailing Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`AAA`	Subscriber Request Validation	Situational	9
`DMG`	Subscriber Demographic Information	Situational	1
`INS`	Subscriber Relationship	Situational	1
Loop 2000E	Patient Event Level	Situational	>1
`HL`	Patient Event Level	Required	1
`TRN`	Patient Event Tracking Number	Situational	3
`AAA`	Patient Event Request Validation	Situational	9
`UM`	Health Care Services Review Information	Required	1
`HCR`	Health Care Services Review	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Administrative Reference Number	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Accident Date	Situational	1
`DTP`	Last Menstrual Period Date	Situational	1
`DTP`	Estimated Dateof Birth	Situational	1
`DTP`	Onsetof Current Symptomsor Illness Date	Situational	1
`DTP`	Event Date	Situational	1
`DTP`	Admission Date	Situational	1
`DTP`	Discharge Date	Situational	1
`DTP`	Certification Issue Date	Situational	1
`DTP`	Certification Expiration Date	Situational	1
`DTP`	Certification Effective Date	Situational	1
`HI`	Patient Diagnosis	Situational	1
`HSD`	Health Care Services Delivery	Situational	1
`CL1`	Institutional Claim Code	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
`CR5`	Home Oxygen Therapy Information	Situational	1
`CR6`	Home Health Care Information	Situational	1
`PWK`	Additional Patient Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010EA	Patient Event Provider Name	Situational	14
`NM1`	Patient Event Provider Name	Required	1
`REF`	Patient Event Provider Supplemental Identification	Situational	7
`N3`	Patient Event Provider Address	Situational	1
`N4`	Patient Event Provider City State ZIP Code	Situational	1
`PER`	Provider Contact Information	Situational	1
`AAA`	Patient Event Provider Request Validation	Situational	9
`PRV`	Patient Event Provider Information	Situational	1
Loop 2010EB	Additional Patient Information Contact Name	Situational	1
`NM1`	Additional Patient Information Contact Name	Required	1
`N3`	Additional Patient Information Contact Address	Situational	1
`N4`	Additional Patient Information Contact City State ZIP Code	Situational	1
`PER`	Additional Patient Information Contact Information	Situational	1
Loop 2010EC	Patient Event Transport Information	Situational	5
`NM1`	Patient Event Transport Information	Required	1
`N3`	Patient Event Transport Location Address	Required	1
`N4`	Patient Event Transport Location City State ZIP Code	Required	1
`AAA`	Patient Event Transport Location Request Validation	Situational	9
Loop 2000F	Service Level	Situational	>1
`HL`	Service Level	Required	1
`TRN`	Service Trace Number	Situational	3
`AAA`	Service Request Validation	Situational	9
`UM`	Health Care Services Review Information	Situational	1
`HCR`	Health Care Services Review	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Administrative Reference Number	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Service Date	Situational	1
`DTP`	Certification Issue Date	Situational	1
`DTP`	Certification Expiration Date	Situational	1
`DTP`	Certification Effective Date	Situational	1
`HI`	Request for Additional Information	Situational	1
`SV1`	Professional Service	Situational	1
`SV2`	Institutional Service Line	Situational	1
`SV3`	Dental Service	Situational	1
`TOO`	Tooth Information	Situational	32
`HSD`	Health Care Services Delivery	Situational	1
`PWK`	Additional Service Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010FA	Service Provider Name	Situational	12
`NM1`	Service Provider Name	Required	1
`REF`	Service Provider Supplemental Identification	Situational	8
`N3`	Service Provider Address	Situational	1
`N4`	Service Provider City State ZIP Code	Situational	1
`PER`	Service Provider Contact Information	Situational	1
`AAA`	Service Provider Request Validation	Situational	9
`PRV`	Service Provider Information	Situational	1
Loop 2010FB	Additional Service Information Contact Name	Situational	1
`NM1`	Additional Service Information Contact Name	Required	1
`N3`	Additional Service Information Contact Address	Situational	1
`N4`	Additional Service Information Contact City State ZIP Code	Required	1
`PER`	Additional Service Information Contact Information	Situational	1
Loop 2000D	Dependent Level	Situational	1
`HL`	Dependent Level	Required	1
Loop 2010D	Dependent Name	Required	1
`NM1`	Dependent Name	Required	1
`REF`	Dependent Supplemental Identification	Situational	3
`N3`	Dependent Address	Situational	1
`N4`	Dependent City State ZIP Code	Situational	1
`AAA`	Dependent Request Validation	Situational	9
`DMG`	Dependent Demographic Information	Situational	1
`INS`	Dependent Relationship	Situational	1
Loop 2000E	Patient Event Level	Situational	>1
`HL`	Patient Event Level	Required	1
`TRN`	Patient Event Tracking Number	Situational	3
`AAA`	Patient Event Request Validation	Situational	9
`UM`	Health Care Services Review Information	Required	1
`HCR`	Health Care Services Review	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Administrative Reference Number	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Accident Date	Situational	1
`DTP`	Last Menstrual Period Date	Situational	1
`DTP`	Estimated Dateof Birth	Situational	1
`DTP`	Onsetof Current Symptomsor Illness Date	Situational	1
`DTP`	Event Date	Situational	1
`DTP`	Admission Date	Situational	1
`DTP`	Discharge Date	Situational	1
`DTP`	Certification Issue Date	Situational	1
`DTP`	Certification Expiration Date	Situational	1
`DTP`	Certification Effective Date	Situational	1
`HI`	Patient Diagnosis	Situational	1
`HSD`	Health Care Services Delivery	Situational	1
`CL1`	Institutional Claim Code	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
`CR5`	Home Oxygen Therapy Information	Situational	1
`CR6`	Home Health Care Information	Situational	1
`PWK`	Additional Patient Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010EA	Patient Event Provider Name	Situational	14
`NM1`	Patient Event Provider Name	Required	1
`REF`	Patient Event Provider Supplemental Identification	Situational	7
`N3`	Patient Event Provider Address	Situational	1
`N4`	Patient Event Provider City State ZIP Code	Situational	1
`PER`	Provider Contact Information	Situational	1
`AAA`	Patient Event Provider Request Validation	Situational	9
`PRV`	Patient Event Provider Information	Situational	1
Loop 2010EB	Additional Patient Information Contact Name	Situational	1
`NM1`	Additional Patient Information Contact Name	Required	1
`N3`	Additional Patient Information Contact Address	Situational	1
`N4`	Additional Patient Information Contact City State ZIP Code	Situational	1
`PER`	Additional Patient Information Contact Information	Situational	1
Loop 2010EC	Patient Event Transport Information	Situational	5
`NM1`	Patient Event Transport Information	Required	1
`N3`	Patient Event Transport Location Address	Required	1
`N4`	Patient Event Transport Location City State ZIP Code	Required	1
`AAA`	Patient Event Transport Location Request Validation	Situational	9
Loop 2000F	Service Level	Situational	>1
`HL`	Service Level	Required	1
`TRN`	Service Trace Number	Situational	3
`AAA`	Service Request Validation	Situational	9
`UM`	Health Care Services Review Information	Situational	1
`HCR`	Health Care Services Review	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Administrative Reference Number	Situational	1
`REF`	Previous Review Authorization Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Service Date	Situational	1
`DTP`	Certification Issue Date	Situational	1
`DTP`	Certification Expiration Date	Situational	1
`DTP`	Certification Effective Date	Situational	1
`HI`	Request for Additional Information	Situational	1
`SV1`	Professional Service	Situational	1
`SV2`	Institutional Service Line	Situational	1
`SV3`	Dental Service	Situational	1
`TOO`	Tooth Information	Situational	32
`HSD`	Health Care Services Delivery	Situational	1
`PWK`	Additional Service Information	Situational	10
`MSG`	Message Text	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2010FA	Service Provider Name	Situational	12
`NM1`	Service Provider Name	Required	1
`REF`	Service Provider Supplemental Identification	Situational	8
`N3`	Service Provider Address	Situational	1
`N4`	Service Provider City State ZIP Code	Situational	1
`PER`	Service Provider Contact Information	Situational	1
`AAA`	Service Provider Request Validation	Situational	9
`PRV`	Service Provider Information	Situational	1
Loop 2010FB	Additional Service Information Contact Name	Situational	1
`NM1`	Additional Service Information Contact Name	Required	1
`N3`	Additional Service Information Contact Address	Situational	1
`N4`	Additional Service Information Contact City State ZIP Code	Required	1
`PER`	Additional Service Information Contact Information	Situational	1
`SE`	Transaction Set Trailer	Required	1

Sample 278 file

A request for review of a planned service. Paste it into EdiNation to see every element named and validated.

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*^*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X217~
ST*278*0001*005010X217~
BHT*0007*13*A12345*20050502*1101~
HL*1**20*1~
NM1*X3*2*MARYLAND CAPITAL INSURANCE COMPANY*****46*789312~
HL*2*1*21*1~
NM1*1P*1*GARDENER*JAMES****46*8189991234~
HL*3*2*22*1~
NM1*IL*1*SMITH*JOE****MI*12345678901~
HL*4*3*EV*0~
TRN*1*111099*9012345678~
UM*SC*I*3*11:B*****Y~
HI*BF:41090:D8:20050430~
HSD*VS*1~
NM1*SJ*1*WATSON*SUSAN****34*987654321~
PER*IC**TE*4029993456~
SE*16*0001~
GE*1*101~
IEA*1*000000101~

The same 278 as JSON

ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.

{
  "ST": {
    "TransactionSetIdentifierCode_01": "278",
    "TransactionSetControlNumber_02": "0001",
    "ImplementationConventionPreference_03": "005010X217"
  },
  "LoopBHT": {
    "BHT_BeginningOfHierarchicalTransaction": {
      "HierarchicalStructureCode_01": "0007",
      "TransactionSetPurposeCode_02": "13",
      "SubmitterTransactionIdentifier_03": "A12345",
      "TransactionSetCreationDate_04": "20050502",
      "TransactionSetCreationTime_05": "1101"
    },
    "Loop2000A": {
      "HL_UtilizationManagementOrganization_UMO_Level": {
        "HierarchicalIDNumber_01": "1",
        "HierarchicalLevelCode_03": "20",
        "HierarchicalChildCode_04": "1"
      },
      "Loop2010A": {
        "NM1_UtilizationManagementOrganization_UMO_Name": {
          "EntityIdentifierCode_01": "X3",
          "EntityTypeQualifier_02": "2",
          "ResponseContactLastorOrganizationName_03": "MARYLAND CAPITAL INSURANCE COMPANY",
          "IdentificationCodeQualifier_08": "46",
          "ResponseContactIdentifier_09": "789312"
        }
      },
      "Loop2000B": {
        "HL_RequesterLevel": {
          "HierarchicalIDNumber_01": "2",
          "HierarchicalParentIDNumber_02": "1",
          "HierarchicalLevelCode_03": "21",
          "HierarchicalChildCode_04": "1"
        },
        "Loop2010B": {
          "NM1_RequesterName": {
            "EntityIdentifierCode_01": "1P",
            "EntityTypeQualifier_02": "1",
            "ResponseContactLastorOrganizationName_03": "GARDENER",
            "ResponseContactFirstName_04": "JAMES",
            "IdentificationCodeQualifier_08": "46",
            "ResponseContactIdentifier_09": "8189991234"
          }
        },
        "Loop2000C": {
          "HL_SubscriberLevel": {
            "HierarchicalIDNumber_01": "3",
            "HierarchicalParentIDNumber_02": "2",
            "HierarchicalLevelCode_03": "22",
            "HierarchicalChildCode_04": "1"
          },
          "Loop2010C": {
            "NM1_SubscriberName": {
              "EntityIdentifierCode_01": "IL",
              "EntityTypeQualifier_02": "1",
              "ResponseContactLastorOrganizationName_03": "SMITH",
              "ResponseContactFirstName_04": "JOE",
              "IdentificationCodeQualifier_08": "MI",
              "ResponseContactIdentifier_09": "12345678901"
            }
          },
          "Loop2000E": {
            "HL_PatientEventLevel": {
              "HierarchicalIDNumber_01": "4",
              "HierarchicalParentIDNumber_02": "3",
              "HierarchicalLevelCode_03": "EV",
              "HierarchicalChildCode_04": "0"
            },
            "TRN_PatientEventTrackingNumber": [
              {
                "TraceTypeCode_01": "1",
                "CurrentTransactionTraceNumber_02": "111099",
                "OriginatingCompanyIdentifier_03": "9012345678"
              }
            ],
            "UM_HealthCareServicesReviewInformation": {
              "RequestCategoryCode_01": "SC",
              "CertificationTypeCode_02": "I",
              "ServiceTypeCode_03": "3",
              "ValuesEntered_04": {
                "FacilityTypeCode_01": "11",
                "FacilityCodeQualifier_02": "B"
              },
              "ReleaseofInformationCode_09": "Y"
            },
            "HI_PatientDiagnosis": {
              "HealthCareCodeInformation_01": {
                "CodeListQualifierCode_01": "BF",
                "IndustryCode_02": "41090",
                "DateTimePeriodFormatQualifier_03": "D8",
                "DateTimePeriod_04": "20050430"
              }
            },
            "HSD_HealthCareServicesDelivery": {
              "QuantityQualifier_01": "VS",
              "BenefitQuantity_02": "1"
            },
            "AllNM1": {
              "Loop2010EA": [
                {
                  "NM1_PatientEventProviderName": {
                    "EntityIdentifierCode_01": "SJ",
                    "EntityTypeQualifier_02": "1",
                    "ResponseContactLastorOrganizationName_03": "WATSON",
                    "ResponseContactFirstName_04": "SUSAN",
                    "IdentificationCodeQualifier_08": "34",
                    "ResponseContactIdentifier_09": "987654321"
                  },
                  "PER_PatientEventProviderContactInformation": {
                    "ContactFunctionCode_01": "IC",
                    "CommunicationNumberQualifier_03": "TE",
                    "ResponseContactCommunicationNumber_04": "4029993456"
                  }
                }
              ]
            }
          }
        }
      }
    }
  },
  "SE": {
    "NumberofIncludedSegments_01": "16",
    "TransactionSetControlNumber_02": "0001"
  }
}

Parse and validate a 278 file

Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\ServicesReview.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS278>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 278 example project Walkthrough
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

edi = open("ServicesReview.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
import com.edifabric.nativex12.EdiFabricX12;
import com.edifabric.nativex12.ParseMode;
import com.edifabric.nativex12.ParseResult;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

String edi = Files.readString(Path.of("ServicesReview.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#include "edifabric_x12.h"

const char *serial = "YOUR_SERIAL_KEY";
ef_parse_result result;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial(serial);
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

char *edi = read_file("ServicesReview.txt", NULL);   /* helper in example_all_functions.c */
if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) {
    /* transactions = output[0 .. offset), report = output[offset .. length) */
    fwrite(result.output.data, 1, (size_t)result.output.length, stdout);
    ef_free(result.output.data);
} C bindingsediFabric Native
curl -X POST 'https://api.edination.com/v2/x12/read' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/octet-stream' \
--data-binary '@ServicesReview.txt' TranslateValidateediFabric Cloud

Generate a 278 file

Populate a TS278 object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 278 file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS278();

//  Begin transaction set 278, control #0001, and implementation convention reference is 005010X217.
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "278";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X217";

//  Begin Loop BHT
transaction.LoopBHT = new Loop_BHT_278();

//  This transaction is a request using hierarchical structure 0007 (information source, information receiver, subscriber, dependent, event, services). 
//  The originating system has assigned the Submitter Transaction Identifier “A12345" along with the transaction set creation date and time.
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_6();
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0007";
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "13";
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "A12345";
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20050502";
transaction.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1101";

//  Begin 2000A Loop hierarchical level identifies the Insurance Company.
transaction.LoopBHT.Loop2000A = new Loop_2000A_278();

// ... set the remaining loops and segments the same way

// SegmentBuilders is in the Common project of the example repository
using (var stream = new MemoryStream())
{
    using (var writer = new X12Writer(stream))
    {
        writer.Write(SegmentBuilders.BuildIsa("1"));
        writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X217"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 278 build methodExample repository
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

# the transactions JSON returned by ef.parse, edited or produced by your application
transactions = open("ServicesReview.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
import com.edifabric.nativex12.EdiFabricX12;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

// the transactions JSON returned by parse, edited or produced by your application
String transactions = Files.readString(Path.of("ServicesReview.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#include "edifabric_x12.h"

ef_buffer edi;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial("YOUR_SERIAL_KEY");
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

/* the transactions JSON returned by ef_parse, edited or produced by your application */
char *transactions = read_file("ServicesReview.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# the JSON returned by /read, edited or produced by your application
curl -X POST 'https://api.edination.com/v2/x12/write' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/json' \
--data-binary '@ServicesReview.json' \
-o 'ServicesReview.txt' How-tosediFabric Cloud

Complete ediFabric .NET example

A complete C# program for the X12 278, built on TS278 in EdiFabric.Templates.Hipaa. The same code is in the ediFabric .NET examples on GitHub.

using EdiFabric.Framework.Readers;
using EdiFabric.Framework.Writers;
using EdiFabric.Templates.Hipaa5010;
using System.Collections.Generic;
using System.IO;
using System.Linq;
using EdiFabric.Core.Model.Edi;
using EdiFabric.Core.Model.Edi.X12;
using EdiFabric.Examples.X12.Common;

namespace EdiFabric.Examples.X12.T278
{
    class Program
    {
        static void Main(string[] args)
        {
            SerialKey.Set(Common.SerialKey.Get());
            Read();
            Write();
        }

        ///
        /// Read Services Review
        ///
        static void Read()
        {
            var ediStream = File.OpenRead(Directory.GetCurrentDirectory() + @"\..\..\..\Files\Hipaa\ServicesReview.txt");

            List ediItems;
            using (var ediReader = new X12Reader(ediStream, "EdiFabric.Templates.Hipaa"))
                ediItems = ediReader.ReadToEnd().ToList();

            var transactions = ediItems.OfType();

            foreach (var transaction in transactions)
            {
                if (transaction.HasErrors)
                {
                    //  partially parsed
                    var errors = transaction.ErrorContext.Flatten();
                }
            }
        }

        ///
        /// Write Services Review
        ///
        static void Write()
        {
            var transaction = BuildServicesReview("1");

            using (var stream = new MemoryStream())
            {
                using (var writer = new X12Writer(stream))
                {
                    writer.Write(SegmentBuilders.BuildIsa("1"));
                    writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X217"));
                    writer.Write(transaction);
                }

                var ediString = stream.LoadToString();
            }
        }

        ///
        /// Builds services review.
        /// Original from http://www.x12.org/examples/005010X217/referral/X217-referral-request-for-review/
        ///
        static TS278 BuildServicesReview(string controlNumber)
        {
            var result = new TS278();

            //  Begin transaction set 278, control #0001, and implementation convention reference is 005010X217.
            result.ST = new ST();
            result.ST.TransactionSetIdentifierCode_01 = "278";
            result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0');
            result.ST.ImplementationConventionPreference_03 = "005010X217";

            //  Begin Loop BHT
            result.LoopBHT = new Loop_BHT_278();

            //  This transaction is a request using hierarchical structure 0007 (information source, information receiver, subscriber, dependent, event, services).
            //  The originating system has assigned the Submitter Transaction Identifier “A12345" along with the transaction set creation date and time.
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_6();
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0007";
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "13";
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "A12345";
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20050502";
            result.LoopBHT.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1101";

            //  Begin 2000A Loop hierarchical level identifies the Insurance Company.
            result.LoopBHT.Loop2000A = new Loop_2000A_278();

            //  HL count is 1. There is no higher, or parent, HL. This HL code is 20, identifying the information source or the insurance company.
            //  This HL has subordinate levels, or children.
            result.LoopBHT.Loop2000A.HL_UtilizationManagementOrganization_UMO_Level = new HL_UtilizationManagementOrganization();
            result.LoopBHT.Loop2000A.HL_UtilizationManagementOrganization_UMO_Level.HierarchicalIDNumber_01 = "1";
            result.LoopBHT.Loop2000A.HL_UtilizationManagementOrganization_UMO_Level.HierarchicalLevelCode_03 = "20";
            result.LoopBHT.Loop2000A.HL_UtilizationManagementOrganization_UMO_Level.HierarchicalChildCode_04 = "1";

            //  Begin 2010A Loop
            result.LoopBHT.Loop2000A.Loop2010A = new Loop_2010A_278();

            //  The request for a referral is being made to Maryland Capital Insurance Company. Their electronic transmitter identification number is 789312.
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name = new NM1_UtilizationManagementOrganization();
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name.EntityIdentifierCode_01 = "X3";
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name.EntityTypeQualifier_02 = "2";
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name.ResponseContactLastorOrganizationName_03 = "MARYLAND CAPITAL INSURANCE COMPANY";
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name.IdentificationCodeQualifier_08 = "46";
            result.LoopBHT.Loop2000A.Loop2010A.NM1_UtilizationManagementOrganization_UMO_Name.ResponseContactIdentifier_09 = "789312";

            //  End 2010A Loop

            //  Begin 2000B Loop hierarchical level identifies the submitting provider.
            result.LoopBHT.Loop2000A.Loop2000B = new Loop_2000B_278();

            //  HL count is 2. This HL is subordinate to HL*1, the parent HL. This HL code is 21, identifying the information receiver or the referring provider.
            //  This HL has subordinate levels, or children.
            result.LoopBHT.Loop2000A.Loop2000B.HL_RequesterLevel = new HL_RequesterLevel();
            result.LoopBHT.Loop2000A.Loop2000B.HL_RequesterLevel.HierarchicalIDNumber_01 = "2";
            result.LoopBHT.Loop2000A.Loop2000B.HL_RequesterLevel.HierarchicalParentIDNumber_02 = "1";
            result.LoopBHT.Loop2000A.Loop2000B.HL_RequesterLevel.HierarchicalLevelCode_03 = "21";
            result.LoopBHT.Loop2000A.Loop2000B.HL_RequesterLevel.HierarchicalChildCode_04 = "1";

            //  Begin 2010B Loop
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B = new Loop_2010B_278();

            //  The request is being made by James Gardener whose Electronic Transmitter Identification Number is 8189991234.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName = new NM1_RequesterName();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.EntityIdentifierCode_01 = "1P";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.EntityTypeQualifier_02 = "1";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.ResponseContactLastorOrganizationName_03 = "GARDENER";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.ResponseContactFirstName_04 = "JAMES";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.IdentificationCodeQualifier_08 = "46";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2010B.NM1_RequesterName.ResponseContactIdentifier_09 = "8189991234";

            //  End 2010B Loop

            //  Begin 2000C Loop hierarchical level identifies the subscriber, who in this case is also the patient.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C = new Loop_2000C_278();

            //  HL count is 3. This HL is subordinate to HL*2, the parent HL. This HL code is 22, identifying the subscriber. This HL has subordinate levels, or children.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.HL_SubscriberLevel = new HL_SubscriberLevel();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.HL_SubscriberLevel.HierarchicalIDNumber_01 = "3";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.HL_SubscriberLevel.HierarchicalParentIDNumber_02 = "2";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.HL_SubscriberLevel.HierarchicalLevelCode_03 = "22";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.HL_SubscriberLevel.HierarchicalChildCode_04 = "1";

            //  Begin 2010C
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C = new Loop_2010C_278();

            //  The patient’s name is Joe Smith; his Member Identification Number is 12345678901.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName = new NM1_SubscriberName_3();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.EntityIdentifierCode_01 = "IL";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.EntityTypeQualifier_02 = "1";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.ResponseContactLastorOrganizationName_03 = "SMITH";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.ResponseContactFirstName_04 = "JOE";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2010C.NM1_SubscriberName.ResponseContactIdentifier_09 = "12345678901";

            //  End 2010C Loop

            //  Begin 2000E Loop hierarchical level identifies the patient event.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E = new Loop_2000E_278();

            //  HL count is 4. This HL is subordinate to HL*3, the parent HL. This HL code is EV, identifying the patient event.
            //  This HL has no subordinate levels, or children.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HL_PatientEventLevel = new HL_PatientEventLevel();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HL_PatientEventLevel.HierarchicalIDNumber_01 = "4";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HL_PatientEventLevel.HierarchicalParentIDNumber_02 = "3";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HL_PatientEventLevel.HierarchicalLevelCode_03 = "EV";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HL_PatientEventLevel.HierarchicalChildCode_04 = "0";

            //  Repeating TRN
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.TRN_PatientEventTrackingNumber = new List();

            //  The provider assigned the trace number 111099 to this service request.
            //  The requester has included the user-assigned identifier of 012345678 to this trace number.
            var trn = new TRN_PatientEventTrackingNumber();
            trn.TraceTypeCode_01 = "1";
            trn.CurrentTransactionTraceNumber_02 = "111099";
            trn.OriginatingCompanyIdentifier_03 = "9012345678";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.TRN_PatientEventTrackingNumber.Add(trn);

            //  Dr. Gardener is requesting an initial consultation for the patient.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation = new UM_HealthCareServicesReviewInformation_3();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.RequestCategoryCode_01 = "SC";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.CertificationTypeCode_02 = "I";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.ServiceTypeCode_03 = "3";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.ValuesEntered_04 = new C023_HealthCareServiceLocationInformation_4();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.ValuesEntered_04.FacilityTypeCode_01 = "11";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.ValuesEntered_04.FacilityCodeQualifier_02 = "B";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.UM_HealthCareServicesReviewInformation.ReleaseofInformationCode_09 = "Y";

            //  The patient has been diagnosed with acute myocardial infarction; unspecified site.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis = new HI_PatientDiagnosis();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis.HealthCareCodeInformation_01 = new C022_HealthCareCodeInformation_24();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis.HealthCareCodeInformation_01.CodeListQualifierCode_01 = "BF";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis.HealthCareCodeInformation_01.IndustryCode_02 = "41090";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis.HealthCareCodeInformation_01.DateTimePeriodFormatQualifier_03 = "D8";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HI_PatientDiagnosis.HealthCareCodeInformation_01.DateTimePeriod_04 = "20050430";

            //  Dr. Gardener is requesting a single visit.
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HSD_HealthCareServicesDelivery = new HSD_HealthCareServicesDelivery_2();
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HSD_HealthCareServicesDelivery.QuantityQualifier_01 = "VS";
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.HSD_HealthCareServicesDelivery.BenefitQuantity_02 = "1";

            //  Occurrence of NM1 Loops in any order
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.AllNM1 = new All_NM1_278_2();

            //  Repeating 2010EA Loops
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.AllNM1.Loop2010EA = new List();

            //  Begin 2010EA Loop
            var loop2010Ea = new Loop_2010EA_278();

            //  The patient event provider is identified as Susan Watson. Her Social Security Number is 987654321.
            loop2010Ea.NM1_PatientEventProviderName = new NM1_PatientEventProviderName();
            loop2010Ea.NM1_PatientEventProviderName.EntityIdentifierCode_01 = "SJ";
            loop2010Ea.NM1_PatientEventProviderName.EntityTypeQualifier_02 = "1";
            loop2010Ea.NM1_PatientEventProviderName.ResponseContactLastorOrganizationName_03 = "WATSON";
            loop2010Ea.NM1_PatientEventProviderName.ResponseContactFirstName_04 = "SUSAN";
            loop2010Ea.NM1_PatientEventProviderName.IdentificationCodeQualifier_08 = "34";
            loop2010Ea.NM1_PatientEventProviderName.ResponseContactIdentifier_09 = "987654321";

            //  Dr. Watson can be contacted by telephone at (402)999-3456.
            loop2010Ea.PER_PatientEventProviderContactInformation = new PER_PatientEventProviderContactInformation();
            loop2010Ea.PER_PatientEventProviderContactInformation.ContactFunctionCode_01 = "IC";
            loop2010Ea.PER_PatientEventProviderContactInformation.CommunicationNumberQualifier_03 = "TE";
            loop2010Ea.PER_PatientEventProviderContactInformation.ResponseContactCommunicationNumber_04 = "4029993456";

            //  End 2010EA Loop
            result.LoopBHT.Loop2000A.Loop2000B.Loop2000C.Loop2000E.AllNM1.Loop2010EA.Add(loop2010Ea);

            //  End 2000E Loop

            //  End 2000C Loop

            //  End 2000B Loop

            //  End 2000A Loop

            //  End Loop BHT

            return result;
        }
    }
}

More operations in ediFabric .NET

278 questions

Is the 278 request the same transaction as the response?

Yes. Both are ST*278 with the same implementation guide. BHT02 and the presence of HCR segments show whether a document is a request or a response.

Where is the authorization decision?

In the HCR segment. HCR01 A1 means certified in total, A3 not certified, A4 pended and A6 modified. HCR02 carries the authorization or reference number.

Is prior authorization done in real time?

It can be. The 278 is exchanged both in real time and in batch, depending on the payer's connectivity.

How do I parse and generate X12 278 files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS278 objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 278 files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 270 - Eligibility, Coverage or Benefit Inquiry
X12 271 - Eligibility, Coverage or Benefit Information
X12 837P - Health Care Claim: Professional
All EDI transactions →

X12 278 Health Care Services Review: Request for Review and Response Last updated: 2026-09-29