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.
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
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.