Prior Authorization/Referral Request and Inpatient Admission/Discharge Notification transactions coming soon
Prior Authorization and Referral Request (278)
The EDI 278 transaction supports healthcare providers to submit an authorization and referral requests electronically. A prior authorization issued by Anthem provides you the go-ahead to perform the necessary service and a referral used to refer a member to a specialty provider. Transmit this transaction in real-time or batch mode. You will receive confirmation numbers to validate receipt of request.
Inpatient Admission and Discharge Notification 278N
Use the Hospital Admission Notification (278N) transaction to exchange admission notification data between an inpatient facility and Anthem in a standard format.
Similar to the HIPAA 278 transaction that you may already use to submit authorizations or referrals, the EDI 278N is the simplest, most efficient way to communicate facility admissions. You can also transmit through Availity in either batch or real-time format.
What are the benefits of 278 and 278N transaction?
Both transactions offer:
- Simplify administrative tasks and increase productivity.
- Reduce administrative costs through automation and fewer phone calls, faxes or keying.
- Increase data accuracy by reducing manual errors.
Specifically for 278N, hospitals that have implemented EDI 278N:
- Experience an improvement in notification submissions within 24 hours.
- Can confirm a notification of admission is on file in the form of a service reference number generated upon registration.
- Submit notification of discharge.
How to send a 278 and 278N Transaction
Look for more communications coming soon around how to work with your practice management software vendor or billing/service clearinghouse, or view a companion guide to send a 278 or 278N transaction.
Where to find help
The new Prior Authorization and Inpatient Admission & Discharge Notification via Electronic and Digital Self Service, X12 5010v Companion Guides, assists with specific 278 and 278N requirements.
- The companion guide can be download at: anthem.com/edi
- Availity documentation can be found at: availity.com
Use the Availity Welcome Application to begin the process of connecting to the Availity EDI Gateway for your Anthem EDI transmissions. In addition, the Availity Quick Start Guide will assist you with any EDI connection questions.
If you need assistance, contact Availity Client Services at 1-800-Availity (1-800-282-4548), Monday through Friday 8 a.m. to 7:30 p.m. Eastern Time.
August 2020 Anthem Provider News and Important Updates -- Colorado