EDI 278 Segments and Elements for the Health Care Services Review Information Standard

AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI278HIHealth Care Services Review Information InsuranceDownload

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See the list of EDI 278 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 278 (Health Care Services Review Information) document into a CSV file. If you are researching the 278s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

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The EDI 278 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BHTBeginning Of Hierarchical TransactionHM011
HLHierarchical LevelDM99999912
AAARequest ValidationDO094
UMHealth Care Services Review InformationDO015
HCRHealth Care Services ReviewDO016
REFReference InformationDO097
DTPDate Or Time Or PeriodDO098
HIHealth Care Information CodesDO019
SV1Professional ServiceDO0110
SV2Institutional ServiceDO0111
SV3Dental ServiceDO0112
TOOTooth IdentificationDO03213
HSDHealth Care Services DeliveryDO0114
CRCConditions IndicatorDO0915
CL1Claim CodesDO0116
CR1Ambulance CertificationDO0117
CR2Chiropractic CertificationDO0118
CR4Enteral Or Parenteral Therapy CertificationDO0119
CR5Oxygen Therapy CertificationDO0120
CR6Home Health Care CertificationDO0121
CR7Home Health Treatment Plan CertificationDO0122
CR8Pacemaker CertificationDO0123
MSGMessage TextDO0125
NM1Individual Or Organizational NameDO999999126
REFReference InformationDO0927
N2Additional Name InformationDO0128
N3Party LocationDO0129
N4Geographic LocationDO0130
PERAdministrative Communications ContactDO0331
AAARequest ValidationDO0932
PRVProvider InformationDO0133
DMGDemographic InformationDO0134
INSInsured BenefitDO0135
DTPDate Or Time Or PeriodDO0936

SegmentElementDescriptionReqMin LengthMax LengthType
BHT1Hierarchical Structure CodeM44ID
BHT2Transaction Set Purpose CodeM22ID
BHT3Reference IdentificationO150AN
BHT6Transaction Type CodeO22ID
HL1Hierarchical Id NumberM112AN
HL2Hierarchical Parent Id NumberO112AN
HL3Hierarchical Level CodeM12ID
HL4Hierarchical Child CodeO11ID
TRN1Trace Type CodeM12ID
TRN2Reference IdentificationM150AN
TRN3Originating Company IdentifierO1010AN
TRN4Reference IdentificationO150AN
AAA1Yes/No Condition Or Response CodeM11ID
AAA2Agency Qualifier CodeO22ID
AAA3Reject Reason CodeO22ID
AAA4Follow-Up Action CodeO11ID
UM1Request Category CodeM12ID
UM2Certification Type CodeO11ID
UM3Service Type CodeO12ID
UM4Facility Code ValueO12AN
UM5Facility Code QualifierO12ID
UM6Claim Frequency Type CodeO11ID
UM7Related-Causes CodeO23ID
UM8Related-Causes CodeO23ID
UM9Related-Causes CodeO23ID
UM10State Or Province CodeO22ID
UM11Country CodeO23ID
UM12Level Of Service CodeO13ID
UM13Current Health Condition CodeO11ID
UM14Prognosis CodeO11ID
UM15Release Of Information CodeO11ID
UM16Delay Reason CodeO12ID
HCR1Action CodeM12ID
HCR2Reference IdentificationO150AN
HCR3Industry CodeO130AN
HCR4Yes/No Condition Or Response CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
HI1Code List Qualifier CodeM13ID
HI2Industry CodeM130AN
HI3Date Time Period Format QualifierM23ID
HI4Date Time PeriodM135AN
HI5Monetary AmountM118R
HI7Version IdentifierM130AN
HI8Industry CodeM130AN
HI9Yes/No Condition Or Response CodeM11ID
HI10Code List Qualifier CodeO13ID
HI11Industry CodeO130AN
HI12Date Time Period Format QualifierO23ID
HI13Date Time PeriodO135AN
HI14Monetary AmountO118R
HI16Version IdentifierO130AN
HI17Industry CodeO130AN
HI18Yes/No Condition Or Response CodeO11ID
HI19Code List Qualifier CodeO13ID
HI20Industry CodeO130AN
HI21Date Time Period Format QualifierO23ID
HI22Date Time PeriodO135AN
HI23Monetary AmountO118R
HI25Version IdentifierO130AN
HI26Industry CodeO130AN
HI27Yes/No Condition Or Response CodeO11ID
HI28Code List Qualifier CodeO13ID
HI29Industry CodeO130AN
HI30Date Time Period Format QualifierO23ID
HI31Date Time PeriodO135AN
HI32Monetary AmountO118R
HI34Version IdentifierO130AN
HI35Industry CodeO130AN
HI36Yes/No Condition Or Response CodeO11ID
HI37Code List Qualifier CodeO13ID
HI38Industry CodeO130AN
HI39Date Time Period Format QualifierO23ID
HI40Date Time PeriodO135AN
HI41Monetary AmountO118R
HI43Version IdentifierO130AN
HI44Industry CodeO130AN
HI45Yes/No Condition Or Response CodeO11ID
HI46Code List Qualifier CodeO13ID
HI47Industry CodeO130AN
HI48Date Time Period Format QualifierO23ID
HI49Date Time PeriodO135AN
HI50Monetary AmountO118R
HI52Version IdentifierO130AN
HI53Industry CodeO130AN
HI54Yes/No Condition Or Response CodeO11ID
HI55Code List Qualifier CodeO13ID
HI56Industry CodeO130AN
HI57Date Time Period Format QualifierO23ID
HI58Date Time PeriodO135AN
HI59Monetary AmountO118R
HI61Version IdentifierO130AN
HI62Industry CodeO130AN
HI63Yes/No Condition Or Response CodeO11ID
HI64Code List Qualifier CodeO13ID
HI65Industry CodeO130AN
HI66Date Time Period Format QualifierO23ID
HI67Date Time PeriodO135AN
HI68Monetary AmountO118R
HI70Version IdentifierO130AN
HI71Industry CodeO130AN
HI72Yes/No Condition Or Response CodeO11ID
HI73Code List Qualifier CodeO13ID
HI74Industry CodeO130AN
HI75Date Time Period Format QualifierO23ID
HI76Date Time PeriodO135AN
HI77Monetary AmountO118R
HI79Version IdentifierO130AN
HI80Industry CodeO130AN
HI81Yes/No Condition Or Response CodeO11ID
HI82Code List Qualifier CodeO13ID
HI83Industry CodeO130AN
HI84Date Time Period Format QualifierO23ID
HI85Date Time PeriodO135AN
HI86Monetary AmountO118R
HI88Version IdentifierO130AN
HI89Industry CodeO130AN
HI90Yes/No Condition Or Response CodeO11ID
HI91Code List Qualifier CodeO13ID
HI92Industry CodeO130AN
HI93Date Time Period Format QualifierO23ID
HI94Date Time PeriodO135AN
HI95Monetary AmountO118R
HI97Version IdentifierO130AN
HI98Industry CodeO130AN
HI99Yes/No Condition Or Response CodeO11ID
HI100Code List Qualifier CodeO13ID
HI101Industry CodeO130AN
HI102Date Time Period Format QualifierO23ID
HI103Date Time PeriodO135AN
HI104Monetary AmountO118R
HI106Version IdentifierO130AN
HI107Industry CodeO130AN
HI108Yes/No Condition Or Response CodeO11ID
SV11Product/Service Id QualifierM22ID
SV12Product/Service IdM148AN
SV13Procedure ModifierM22AN
SV14Procedure ModifierM22AN
SV15Procedure ModifierM22AN
SV16Procedure ModifierM22AN
SV18Product/Service IdM148AN
SV19Monetary AmountO118R
SV110Unit Or Basis For Measurement CodeC22ID
SV112Facility Code ValueO12AN
SV113Service Type CodeO12ID
SV114Diagnosis Code PointerO12N0
SV115Diagnosis Code PointerO12N0
SV116Diagnosis Code PointerO12N0
SV117Diagnosis Code PointerO12N0
SV118Monetary AmountO118R
SV119Yes/No Condition Or Response CodeO11ID
SV120Multiple Procedure CodeO12ID
SV121Yes/No Condition Or Response CodeO11ID
SV122Yes/No Condition Or Response CodeO11ID
SV123Review CodeO12ID
SV124National Or Local Assigned Review ValueO12AN
SV125Copay Status CodeO11ID
SV126Health Care Professional Shortage Area CodeO11ID
SV127Reference IdentificationO150AN
SV128Postal CodeO315ID
SV129Monetary AmountO118R
SV130Level Of Care CodeO11ID
SV131Provider Agreement CodeO11ID
SV21Product/Service IdC148AN
SV22Product/Service Id QualifierC22ID
SV23Product/Service IdC148AN
SV24Procedure ModifierC22AN
SV25Procedure ModifierC22AN
SV26Procedure ModifierC22AN
SV27Procedure ModifierC22AN
SV29Product/Service IdC148AN
SV210Monetary AmountO118R
SV211Unit Or Basis For Measurement CodeC22ID
SV213Unit RateO110R
SV214Monetary AmountO118R
SV215Yes/No Condition Or Response CodeO11ID
SV216Nursing Home Residential Status CodeO11ID
SV217Level Of Care CodeO11ID
SV31Product/Service Id QualifierM22ID
SV32Product/Service IdM148AN
SV33Procedure ModifierM22AN
SV34Procedure ModifierM22AN
SV35Procedure ModifierM22AN
SV36Procedure ModifierM22AN
SV38Product/Service IdM148AN
SV39Monetary AmountO118R
SV310Facility Code ValueO12AN
SV311Oral Cavity Designation CodeO13ID
SV312Oral Cavity Designation CodeO13ID
SV313Oral Cavity Designation CodeO13ID
SV314Oral Cavity Designation CodeO13ID
SV315Oral Cavity Designation CodeO13ID
SV316Prosthesis, Crown Or Inlay CodeO11ID
SV319Copay Status CodeO11ID
SV320Provider Agreement CodeO11ID
SV321Yes/No Condition Or Response CodeO11ID
SV322Diagnosis Code PointerO12N0
SV323Diagnosis Code PointerO12N0
SV324Diagnosis Code PointerO12N0
SV325Diagnosis Code PointerO12N0
TOO1Code List Qualifier CodeC13ID
TOO2Industry CodeC130AN
TOO3Tooth Surface CodeO12ID
TOO4Tooth Surface CodeO12ID
TOO5Tooth Surface CodeO12ID
TOO6Tooth Surface CodeO12ID
TOO7Tooth Surface CodeO12ID
HSD1Quantity QualifierC22ID
HSD3Unit Or Basis For Measurement CodeO22ID
HSD4Sample Selection ModulusO16R6
HSD5Time Period QualifierC12ID
HSD6Number Of PeriodsO13N0
HSD7Ship/Delivery Or Calendar Pattern CodeO12ID
HSD8Ship/Delivery Pattern Time CodeO11ID
CRC1Code CategoryM22ID
CRC2Yes/No Condition Or Response CodeM11ID
CRC3Condition IndicatorM23ID
CRC4Condition IndicatorO23ID
CRC5Condition IndicatorO23ID
CRC6Condition IndicatorO23ID
CRC7Condition IndicatorO23ID
CL11Admission Type CodeO11ID
CL12Admission Source CodeO11ID
CL13Patient Status CodeO12ID
CL14Nursing Home Residential Status CodeO11ID
CR11Unit Or Basis For Measurement CodeC22ID
CR13Ambulance Transport CodeO11ID
CR14Ambulance Transport Reason CodeO11ID
CR15Unit Or Basis For Measurement CodeC22ID
CR17Address InformationO155AN
CR18Address InformationO155AN
CR23Subluxation Level CodeC23ID
CR24Subluxation Level CodeO23ID
CR25Unit Or Basis For Measurement CodeC22ID
CR28Nature Of Condition CodeO11ID
CR29Yes/No Condition Or Response CodeO11ID
CR212Yes/No Condition Or Response CodeO11ID
CR41Yes/No Condition Or Response CodeM11ID
CR42Certification Type CodeO11ID
CR43Unit Or Basis For Measurement CodeC22ID
CR45Unit Or Basis For Measurement CodeC22ID
CR47Non-Visit CodeO11ID
CR48Unit Or Basis For Measurement CodeC22ID
CR410Unit Or Basis For Measurement CodeC22ID
CR412Unit Or Basis For Measurement CodeC22ID
CR416Nutrient Administration Method CodeO11ID
CR417Nutrient Administration Technique CodeO11ID
CR422Percentage As DecimalO110R
CR425Percentage As DecimalO110R
CR427Percentage As DecimalO110R
CR51Certification Type CodeO11ID
CR53Oxygen Equipment Type CodeO11ID
CR54Oxygen Equipment Type CodeO11ID
CR512Oxygen Test Condition CodeO11ID
CR513Oxygen Test Findings CodeO11ID
CR514Oxygen Test Findings CodeO11ID
CR515Oxygen Test Findings CodeO11ID
CR517Oxygen Delivery System CodeO11ID
CR518Oxygen Equipment Type CodeO11ID
CR61Prognosis CodeM11ID
CR63Date Time Period Format QualifierC23ID
CR64Date Time PeriodC135AN
CR66Yes/No Condition Or Response CodeO11ID
CR67Yes/No Condition Or Response CodeM11ID
CR68Certification Type CodeM11ID
CR610Product/Service Id QualifierC22ID
CR611Medical Code ValueC115AN
CR615Date Time Period Format QualifierC23ID
CR616Date Time PeriodC135AN
CR617Patient Location CodeC11ID
CR71Discipline Type CodeM22ID
CR81Implant Type CodeM11ID
CR82Implant Status CodeM11ID
CR85Reference IdentificationM150AN
CR86Reference IdentificationM150AN
CR87Reference IdentificationM150AN
CR88Yes/No Condition Or Response CodeM11ID
CR89Yes/No Condition Or Response CodeM11ID
PWK1Report Type CodeM22ID
PWK2Report Transmission CodeO12ID
PWK3Report Copies NeededO12N0
PWK4Entity Identifier CodeO23ID
PWK5Identification Code QualifierC12ID
PWK6Identification CodeC280AN
PWK8Paperwork/Report Action CodeO12ID
PWK9Paperwork/Report Action CodeO12ID
PWK10Paperwork/Report Action CodeO12ID
PWK11Paperwork/Report Action CodeO12ID
PWK12Paperwork/Report Action CodeO12ID
PWK13Request Category CodeO12ID
MSG1Free-Form Message TextM1264AN
MSG2Printer Carriage Control CodeC22ID
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
AAA1Yes/No Condition Or Response CodeM11ID
AAA2Agency Qualifier CodeO22ID
AAA3Reject Reason CodeO22ID
AAA4Follow-Up Action CodeO11ID
PRV1Provider CodeM13ID
PRV2Reference Identification QualifierC23ID
PRV3Reference IdentificationC150AN
PRV4State Or Province CodeO22ID
PRV5Provider Specialty CodeO13AN
PRV6Agency Qualifier CodeO22ID
PRV7Yes/No Condition Or Response CodeO11ID
PRV8Provider Organization CodeO33ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
INS1Yes/No Condition Or Response CodeM11ID
INS2Individual Relationship CodeM22ID
INS3Maintenance Type CodeO33ID
INS4Maintenance Reason CodeO23ID
INS5Benefit Status CodeO11ID
INS6Medicare Plan CodeO11ID
INS7Eligibility Reason CodeO11ID
INS8Eligibility Reason CodeO11ID
INS9Eligibility Reason CodeO11ID
INS10Consolidated Omnibus Budget Reconciliation Act (Cobra) QualifyingO12ID
INS11Employment Status CodeO22ID
INS12Student Status CodeO11ID
INS13Yes/No Condition Or Response CodeO11ID
INS14Date Time Period Format QualifierC23ID
INS15Date Time PeriodC135AN
INS16Confidentiality CodeO11ID
INS17City NameO230AN
INS18State Or Province CodeO22ID
INS19Country CodeO23ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN

Official Definition:
Data contents of the Health Care Services Review Information Transaction Set (278) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to transmit health care service information, such as subscriber, patient, demographic, diagnosis or treatment data for the purpose of request for review, certification, notification or reporting the outcome of a health care services review. Expected users of this transaction set are payors, plan sponsors, providers, utilization management and other entities involved in health care services review.

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