Make the change to digital authorization/referral and hospital admission notifications using EDI
Anthem Blue Cross and Blue Shield (Anthem) and Availity are excited to announce the Prior Authorization and Referrals (278) and Inpatient Admission and Discharge Notification (278N) 5010 transactions functionality.
Prior Authorization and Referral Request (278)
Use this transaction to electronically submit authorization and referral requests. You have the option to transmit this transaction in real-time or batch mode, and you will receive confirmation numbers to validate receipt of request.
- An authorization is a review and approval of specific services
- A referral is used to refer a patient to a specialty provider
Hospital Admission Notification (278N)
Use this transaction to electronically submit hospital admission notifications between your facility and health plan. The EDI 278N is the easiest, most efficient way to communicate facility admissions. Just like the 278, you can also transmit in either batch or real-time format which includes the ability to update a previously submitted date.
What are your benefits for using these transactions?
- Streamline administrative tasks and increase productivity
- Reduce administrative costs through automation
- Increase data accuracy by reducing manual errors
- Confirm a notification of admission is on file in the form of a service reference number that is generated upon registration
- Submit notification of discharge
- Accomplish more with less ‒ fewer phone calls, faxes or keying
- If you use a clearinghouse or vendor work with them to ensure they have the capability to exchange these transactions.
- If you use practice management software have your Availity administrator use the following path to enroll:
- My Providers > Enrollment Center > Transaction Enrollment
- Availity EDI Companion Guide communicates Availity-specific requirements and other information that supplements requirements and information already provided in standard EDI and HIPAA communications.
- Anthem specific companion guide communicates requirements for submitting these transactions. These are located on the company website at – anthem.com/edi
- The Availity Quick Start Guide will assist you with any EDI connection questions you might have.
If you need assistance, contact Availity Client Services at 1-800-Availity (1-800-282-4548), Monday through Friday 8 a.m. to 8 p.m. Eastern Time.
April 2021 Anthem Provider News - Wisconsin