278 Health Care Services Review: Request for Review and Response (005010X217)
Providers send the 278 to request prior authorization or referral review, and payers use it to respond. This is the standard X12 HIPAA 005010 spec, with 44 loops and 313 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.
Use the 278 spec in your code
ediFabric .NET
Add the C# template and its common files to your project, or reference the template NuGet package, and read 278 files into TS278 objects. See ediFabric .NET.
ediFabric Native
Map version 005010X217 to the Native model with set_map, then parse 278 files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.
OpenEDI
Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.
Generate 278 classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 278 as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS278. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.
Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.
For a sample file, the same data as JSON, and code to parse, validate and generate the 278, see the 278 transaction guide.
278 structure
Loops and segments of the standard 278, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| Loop BHT | Beginning Of Hierarchical Transaction | Optional | 1 |
| BHT | Beginning Of Hierarchical Transaction | Optional | 1 |
| Loop 2000A | Utilization Management Organization UMO Level | Optional | 1 |
| HL | Utilization Management Organization UMO Level | Mandatory | 1 |
| Loop 2010A | Utilization Management Organization UMO Name | Mandatory | 1 |
| NM1 | Utilization Management Organization UMO Name | Mandatory | 1 |
| Loop 2000B | Requester Level | Mandatory | 1 |
| HL | Requester Level | Mandatory | 1 |
| Loop 2010B | Requester Name | Mandatory | 1 |
| NM1 | Requester Name | Mandatory | 1 |
| REF | Requester Supplemental Identification | Optional | 8 |
| N3 | Requester Address | Optional | 1 |
| N4 | Requester City State ZIP Code | Optional | 1 |
| PER | Requester Contact Information | Optional | 1 |
| PRV | Requester Provider Information | Optional | 1 |
| Loop 2000C | Subscriber Level | Mandatory | 1 |
| HL | Subscriber Level | Mandatory | 1 |
| Loop 2010C | Subscriber Name | Mandatory | 1 |
| NM1 | Subscriber Name | Mandatory | 1 |
| REF | Subscriber Supplemental Identification | Optional | 9 |
| N3 | Subscriber Address | Optional | 1 |
| N4 | Subscriber City State ZIP Code | Optional | 1 |
| DMG | Subscriber Demographic Information | Optional | 1 |
| INS | Subscriber Relationship | Optional | 1 |
| Loop 2000D | Dependent Level | Optional | 1 |
| HL | Dependent Level | Mandatory | 1 |
| Loop 2010D | Dependent Name | Mandatory | 1 |
| NM1 | Dependent Name | Mandatory | 1 |
| REF | Dependent Supplemental Identification | Optional | 3 |
| N3 | Dependent Address | Optional | 1 |
| N4 | Dependent City State ZIP Code | Optional | 1 |
| DMG | Dependent Demographic Information | Optional | 1 |
| INS | Dependent Relationship | Optional | 1 |
| Loop 2000E | Patient Event Level | Mandatory | 1 |
| HL | Patient Event Level | Mandatory | 1 |
| TRN | Patient Event Tracking Number | Optional | 2 |
| UM | Health Care Services Review Information | Mandatory | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| REF | Previous Review Administrative Reference Number | Optional | 1 |
| DTP | Accident Date | Optional | 1 |
| DTP | Last Menstrual Period Date | Optional | 1 |
| DTP | Estimated Dateof Birth | Optional | 1 |
| DTP | Onsetof Current Symptomsor Illness Date | Optional | 1 |
| DTP | Event Date | Optional | 1 |
| DTP | Admission Date | Optional | 1 |
| DTP | Discharge Date | Optional | 1 |
| HI | Patient Diagnosis | Optional | 1 |
| HSD | Health Care Services Delivery | Optional | 1 |
| CRC | Ambulance Certification Information | Optional | 1 |
| CRC | Chiropractic Certification Information | Optional | 1 |
| CRC | Durable Medical Equipment Information | Optional | 1 |
| CRC | Oxygen Therapy Certification Information | Optional | 1 |
| CRC | Functional Limitations Information | Optional | 1 |
| CRC | Activities Permitted Information | Optional | 1 |
| CRC | Mental Status Information | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| CR1 | Ambulance Transport Information | Optional | 1 |
| CR2 | Spinal Manipulation Service Information | Optional | 1 |
| CR5 | Home Oxygen Therapy Information | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| PWK | Additional Patient Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010EA | Patient Event Provider Name | Optional | 14 |
| NM1 | Patient Event Provider Name | Mandatory | 1 |
| REF | Patient Event Provider Supplemental Information | Optional | 7 |
| N3 | Patient Event Provider Address | Optional | 1 |
| N4 | Patient Event Provider City State Zip Code | Optional | 1 |
| PER | Patient Event Provider Contact Information | Optional | 1 |
| PRV | Patient Event Provider Information | Optional | 1 |
| Loop 2010EB | Patient Event Transport Information | Optional | 5 |
| NM1 | Patient Event Transport Information | Mandatory | 1 |
| N3 | Patient Event Transport Location Address | Mandatory | 1 |
| N4 | Patient Event Transport Location City State ZIP Code | Mandatory | 1 |
| Loop 2010EC | Patient Event Other UMO Name | Optional | 3 |
| NM1 | Patient Event Other UMO Name | Mandatory | 1 |
| REF | Other UMO Denial Reason | Mandatory | 1 |
| DTP | Other UMO Denial Date | Mandatory | 1 |
| Loop 2000F | Service Level | Optional | >1 |
| HL | Service Level | Mandatory | 1 |
| TRN | Service Trace Number | Optional | 2 |
| UM | Health Care Services Review Information | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| REF | Previous Review Administrative Reference Number | Optional | 1 |
| DTP | Service Date | Optional | 1 |
| SV1 | Professional Service | Optional | 1 |
| SV2 | Institutional Service Line | Optional | 1 |
| SV3 | Dental Service | Optional | 1 |
| TOO | Tooth Information | Optional | 32 |
| HSD | Health Care Services Delivery | Optional | 1 |
| PWK | Additional Service Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010F | Service Provider Name | Optional | 10 |
| NM1 | Service Provider Name | Mandatory | 1 |
| REF | Service Provider Supplemental Identification | Optional | 8 |
| N3 | Service Provider Address | Optional | 1 |
| N4 | Service Provider City State ZIP Code | Optional | 1 |
| PER | Service Provider Contact Information | Optional | 1 |
| PRV | Service Provider Information | Optional | 1 |
| Loop 2000E | Patient Event Level | Optional | 1 |
| HL | Patient Event Level | Mandatory | 1 |
| TRN | Patient Event Tracking Number | Optional | 2 |
| UM | Health Care Services Review Information | Mandatory | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| REF | Previous Review Administrative Reference Number | Optional | 1 |
| DTP | Accident Date | Optional | 1 |
| DTP | Last Menstrual Period Date | Optional | 1 |
| DTP | Estimated Dateof Birth | Optional | 1 |
| DTP | Onsetof Current Symptomsor Illness Date | Optional | 1 |
| DTP | Event Date | Optional | 1 |
| DTP | Admission Date | Optional | 1 |
| DTP | Discharge Date | Optional | 1 |
| HI | Patient Diagnosis | Optional | 1 |
| HSD | Health Care Services Delivery | Optional | 1 |
| CRC | Ambulance Certification Information | Optional | 1 |
| CRC | Chiropractic Certification Information | Optional | 1 |
| CRC | Durable Medical Equipment Information | Optional | 1 |
| CRC | Oxygen Therapy Certification Information | Optional | 1 |
| CRC | Functional Limitations Information | Optional | 1 |
| CRC | Activities Permitted Information | Optional | 1 |
| CRC | Mental Status Information | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| CR1 | Ambulance Transport Information | Optional | 1 |
| CR2 | Spinal Manipulation Service Information | Optional | 1 |
| CR5 | Home Oxygen Therapy Information | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| PWK | Additional Patient Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010EA | Patient Event Provider Name | Optional | 14 |
| NM1 | Patient Event Provider Name | Mandatory | 1 |
| REF | Patient Event Provider Supplemental Information | Optional | 7 |
| N3 | Patient Event Provider Address | Optional | 1 |
| N4 | Patient Event Provider City State Zip Code | Optional | 1 |
| PER | Patient Event Provider Contact Information | Optional | 1 |
| PRV | Patient Event Provider Information | Optional | 1 |
| Loop 2010EB | Patient Event Transport Information | Optional | 5 |
| NM1 | Patient Event Transport Information | Mandatory | 1 |
| N3 | Patient Event Transport Location Address | Mandatory | 1 |
| N4 | Patient Event Transport Location City State ZIP Code | Mandatory | 1 |
| Loop 2010EC | Patient Event Other UMO Name | Optional | 3 |
| NM1 | Patient Event Other UMO Name | Mandatory | 1 |
| REF | Other UMO Denial Reason | Mandatory | 1 |
| DTP | Other UMO Denial Date | Mandatory | 1 |
| Loop 2000F | Service Level | Optional | >1 |
| HL | Service Level | Mandatory | 1 |
| TRN | Service Trace Number | Optional | 2 |
| UM | Health Care Services Review Information | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| REF | Previous Review Administrative Reference Number | Optional | 1 |
| DTP | Service Date | Optional | 1 |
| SV1 | Professional Service | Optional | 1 |
| SV2 | Institutional Service Line | Optional | 1 |
| SV3 | Dental Service | Optional | 1 |
| TOO | Tooth Information | Optional | 32 |
| HSD | Health Care Services Delivery | Optional | 1 |
| PWK | Additional Service Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010F | Service Provider Name | Optional | 10 |
| NM1 | Service Provider Name | Mandatory | 1 |
| REF | Service Provider Supplemental Identification | Optional | 8 |
| N3 | Service Provider Address | Optional | 1 |
| N4 | Service Provider City State ZIP Code | Optional | 1 |
| PER | Service Provider Contact Information | Optional | 1 |
| PRV | Service Provider Information | Optional | 1 |
| Loop BHT | Beginning Of Hierarchical Transaction | Optional | 1 |
| BHT | Beginning Of Hierarchical Transaction | Optional | 1 |
| Loop 2000A | Utilization Management Organization UMO Level | Optional | 1 |
| HL | Utilization Management Organization UMO Level | Mandatory | 1 |
| AAA | Request Validation | Optional | 9 |
| Loop 2010A | Utilization Management Organization UMO Name | Mandatory | 1 |
| NM1 | Utilization Management Organization UMO Name | Mandatory | 1 |
| PER | Utilization Management Organization UMO Contact Information | Optional | 1 |
| AAA | Utilization Management Organization UMO Request Validation | Optional | 9 |
| Loop 2000B | Requester Level | Optional | 1 |
| HL | Requester Level | Mandatory | 1 |
| Loop 2010B | Requester Name | Mandatory | 2 |
| NM1 | Requester Name | Mandatory | 1 |
| REF | Requester Supplemental Identification | Optional | 8 |
| AAA | Requester Request Validation | Optional | 9 |
| PRV | Requester Provider Information | Optional | 1 |
| Loop 2000C | Subscriber Level | Optional | 1 |
| HL | Subscriber Level | Mandatory | 1 |
| Loop 2010C | Subscriber Name | Mandatory | 1 |
| NM1 | Subscriber Name | Mandatory | 1 |
| REF | Subscriber Supplemental Identification | Optional | 9 |
| N3 | Subscriber Mailing Address | Optional | 1 |
| N4 | Subscriber City State ZIP Code | Optional | 1 |
| AAA | Subscriber Request Validation | Optional | 9 |
| DMG | Subscriber Demographic Information | Optional | 1 |
| INS | Subscriber Relationship | Optional | 1 |
| Loop 2000E | Patient Event Level | Optional | >1 |
| HL | Patient Event Level | Mandatory | 1 |
| TRN | Patient Event Tracking Number | Optional | 3 |
| AAA | Patient Event Request Validation | Optional | 9 |
| UM | Health Care Services Review Information | Mandatory | 1 |
| HCR | Health Care Services Review | Optional | 1 |
| REF | Administrative Reference Number | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| DTP | Accident Date | Optional | 1 |
| DTP | Last Menstrual Period Date | Optional | 1 |
| DTP | Estimated Dateof Birth | Optional | 1 |
| DTP | Onsetof Current Symptomsor Illness Date | Optional | 1 |
| DTP | Event Date | Optional | 1 |
| DTP | Admission Date | Optional | 1 |
| DTP | Discharge Date | Optional | 1 |
| DTP | Certification Issue Date | Optional | 1 |
| DTP | Certification Expiration Date | Optional | 1 |
| DTP | Certification Effective Date | Optional | 1 |
| HI | Patient Diagnosis | Optional | 1 |
| HSD | Health Care Services Delivery | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| CR1 | Ambulance Transport Information | Optional | 1 |
| CR2 | Spinal Manipulation Service Information | Optional | 1 |
| CR5 | Home Oxygen Therapy Information | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| PWK | Additional Patient Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010EA | Patient Event Provider Name | Optional | 14 |
| NM1 | Patient Event Provider Name | Mandatory | 1 |
| REF | Patient Event Provider Supplemental Identification | Optional | 7 |
| N3 | Patient Event Provider Address | Optional | 1 |
| N4 | Patient Event Provider City State ZIP Code | Optional | 1 |
| PER | Provider Contact Information | Optional | 1 |
| AAA | Patient Event Provider Request Validation | Optional | 9 |
| PRV | Patient Event Provider Information | Optional | 1 |
| Loop 2010EB | Additional Patient Information Contact Name | Optional | 1 |
| NM1 | Additional Patient Information Contact Name | Mandatory | 1 |
| N3 | Additional Patient Information Contact Address | Optional | 1 |
| N4 | Additional Patient Information Contact City State ZIP Code | Optional | 1 |
| PER | Additional Patient Information Contact Information | Optional | 1 |
| Loop 2010EC | Patient Event Transport Information | Optional | 5 |
| NM1 | Patient Event Transport Information | Mandatory | 1 |
| N3 | Patient Event Transport Location Address | Mandatory | 1 |
| N4 | Patient Event Transport Location City State ZIP Code | Mandatory | 1 |
| AAA | Patient Event Transport Location Request Validation | Optional | 9 |
| Loop 2000F | Service Level | Optional | >1 |
| HL | Service Level | Mandatory | 1 |
| TRN | Service Trace Number | Optional | 3 |
| AAA | Service Request Validation | Optional | 9 |
| UM | Health Care Services Review Information | Optional | 1 |
| HCR | Health Care Services Review | Optional | 1 |
| REF | Administrative Reference Number | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| DTP | Service Date | Optional | 1 |
| DTP | Certification Issue Date | Optional | 1 |
| DTP | Certification Expiration Date | Optional | 1 |
| DTP | Certification Effective Date | Optional | 1 |
| HI | Request For Additional Information | Optional | 1 |
| SV1 | Professional Service | Optional | 1 |
| SV2 | Institutional Service Line | Optional | 1 |
| SV3 | Dental Service | Optional | 1 |
| TOO | Tooth Information | Optional | 32 |
| HSD | Health Care Services Delivery | Optional | 1 |
| PWK | Additional Service Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010FA | Service Provider Name | Optional | 12 |
| NM1 | Service Provider Name | Mandatory | 1 |
| REF | Service Provider Supplemental Identification | Optional | 8 |
| N3 | Service Provider Address | Optional | 1 |
| N4 | Service Provider City State ZIP Code | Optional | 1 |
| PER | Service Provider Contact Information | Optional | 1 |
| AAA | Service Provider Request Validation | Optional | 9 |
| PRV | Service Provider Information | Optional | 1 |
| Loop 2010FB | Additional Service Information Contact Name | Optional | 1 |
| NM1 | Additional Service Information Contact Name | Mandatory | 1 |
| N3 | Additional Service Information Contact Address | Optional | 1 |
| N4 | Additional Service Information Contact City State ZIP Code | Mandatory | 1 |
| PER | Additional Service Information Contact Information | Optional | 1 |
| Loop 2000D | Dependent Level | Optional | 1 |
| HL | Dependent Level | Mandatory | 1 |
| Loop 2010D | Dependent Name | Mandatory | 1 |
| NM1 | Dependent Name | Mandatory | 1 |
| REF | Dependent Supplemental Identification | Optional | 3 |
| N3 | Dependent Address | Optional | 1 |
| N4 | Dependent City State ZIP Code | Optional | 1 |
| AAA | Dependent Request Validation | Optional | 9 |
| DMG | Dependent Demographic Information | Optional | 1 |
| INS | Dependent Relationship | Optional | 1 |
| Loop 2000E | Patient Event Level | Optional | >1 |
| HL | Patient Event Level | Mandatory | 1 |
| TRN | Patient Event Tracking Number | Optional | 3 |
| AAA | Patient Event Request Validation | Optional | 9 |
| UM | Health Care Services Review Information | Mandatory | 1 |
| HCR | Health Care Services Review | Optional | 1 |
| REF | Administrative Reference Number | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| DTP | Accident Date | Optional | 1 |
| DTP | Last Menstrual Period Date | Optional | 1 |
| DTP | Estimated Dateof Birth | Optional | 1 |
| DTP | Onsetof Current Symptomsor Illness Date | Optional | 1 |
| DTP | Event Date | Optional | 1 |
| DTP | Admission Date | Optional | 1 |
| DTP | Discharge Date | Optional | 1 |
| DTP | Certification Issue Date | Optional | 1 |
| DTP | Certification Expiration Date | Optional | 1 |
| DTP | Certification Effective Date | Optional | 1 |
| HI | Patient Diagnosis | Optional | 1 |
| HSD | Health Care Services Delivery | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| CR1 | Ambulance Transport Information | Optional | 1 |
| CR2 | Spinal Manipulation Service Information | Optional | 1 |
| CR5 | Home Oxygen Therapy Information | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| PWK | Additional Patient Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010EA | Patient Event Provider Name | Optional | 14 |
| NM1 | Patient Event Provider Name | Mandatory | 1 |
| REF | Patient Event Provider Supplemental Identification | Optional | 7 |
| N3 | Patient Event Provider Address | Optional | 1 |
| N4 | Patient Event Provider City State ZIP Code | Optional | 1 |
| PER | Provider Contact Information | Optional | 1 |
| AAA | Patient Event Provider Request Validation | Optional | 9 |
| PRV | Patient Event Provider Information | Optional | 1 |
| Loop 2010EB | Additional Patient Information Contact Name | Optional | 1 |
| NM1 | Additional Patient Information Contact Name | Mandatory | 1 |
| N3 | Additional Patient Information Contact Address | Optional | 1 |
| N4 | Additional Patient Information Contact City State ZIP Code | Optional | 1 |
| PER | Additional Patient Information Contact Information | Optional | 1 |
| Loop 2010EC | Patient Event Transport Information | Optional | 5 |
| NM1 | Patient Event Transport Information | Mandatory | 1 |
| N3 | Patient Event Transport Location Address | Mandatory | 1 |
| N4 | Patient Event Transport Location City State ZIP Code | Mandatory | 1 |
| AAA | Patient Event Transport Location Request Validation | Optional | 9 |
| Loop 2000F | Service Level | Optional | >1 |
| HL | Service Level | Mandatory | 1 |
| TRN | Service Trace Number | Optional | 3 |
| AAA | Service Request Validation | Optional | 9 |
| UM | Health Care Services Review Information | Optional | 1 |
| HCR | Health Care Services Review | Optional | 1 |
| REF | Administrative Reference Number | Optional | 1 |
| REF | Previous Review Authorization Number | Optional | 1 |
| DTP | Service Date | Optional | 1 |
| DTP | Certification Issue Date | Optional | 1 |
| DTP | Certification Expiration Date | Optional | 1 |
| DTP | Certification Effective Date | Optional | 1 |
| HI | Request For Additional Information | Optional | 1 |
| SV1 | Professional Service | Optional | 1 |
| SV2 | Institutional Service Line | Optional | 1 |
| SV3 | Dental Service | Optional | 1 |
| TOO | Tooth Information | Optional | 32 |
| HSD | Health Care Services Delivery | Optional | 1 |
| PWK | Additional Service Information | Optional | 10 |
| MSG | Message Text | Optional | 1 |
| Loop 2010FA | Service Provider Name | Optional | 12 |
| NM1 | Service Provider Name | Mandatory | 1 |
| REF | Service Provider Supplemental Identification | Optional | 8 |
| N3 | Service Provider Address | Optional | 1 |
| N4 | Service Provider City State ZIP Code | Optional | 1 |
| PER | Service Provider Contact Information | Optional | 1 |
| AAA | Service Provider Request Validation | Optional | 9 |
| PRV | Service Provider Information | Optional | 1 |
| Loop 2010FB | Additional Service Information Contact Name | Optional | 1 |
| NM1 | Additional Service Information Contact Name | Mandatory | 1 |
| N3 | Additional Service Information Contact Address | Optional | 1 |
| N4 | Additional Service Information Contact City State ZIP Code | Mandatory | 1 |
| PER | Additional Service Information Contact Information | Optional | 1 |
| SE | Transaction Set Trailer | Optional | 1 |