EDI 278: Authorization and Referral Request

Use the Authorization and Referral Request (278) transaction to electronically submit authorization and referral requests. An authorization is a review of services related to an episode of care, and a referral is used to refer a member to a specialty provider.

These transactions can be submitted in real-time or batch mode. Confirmation numbers are returned to validate receipt of request.

Benefits

• Streamline administrative tasks and increase productivity
• Reduce administrative costs through automation
• Increase data accuracy by reducing manual errors
• Accomplish more with less ‒ fewer phone calls, faxes or keying

Getting Started

Please contact your clearinghouse and/or vendor to learn more about the EDI 278 transaction.

The Prior Authorization and Notification section of this website contains information on our care management program, quick reference guides and other tools to support your success with this process.

You can also refer to our Companion Guide page for more information.