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Version: v0.1.12

Read a 278 services review decision

You asked a utilization management organization to authorize a service, and the 278 response came back. You need the certification action (was it certified, pended, denied?) and the authorization number to put on the claim you are about to send.

get278Request(delimiters, tx) and get278Response(delimiters, tx) read the two directions of one implementation guide, 005010X217. Both are 278s, so route on the direction the model reports rather than on ST-01 alone; a reader hands back undefined for a transaction it does not decode. A 278 declaring any other guide is still read, and carries X12_GUIDE_NOT_IMPLEMENTED; that includes 005010X216, the 278 notification guide.

The HCR-01 certification action is the field this library places verbatim and never infers. It is response-only: a request carries no decision at all, and review.decision is undefined there rather than defaulted to anything.

import { parseX12, get278Response } from "@cosyte/x12";

const raw278 = [
  "ISA*00*          *00*          *ZZ*UMOPAYER       *ZZ*SUBMITTER      *260601*1230*^*00501*000000002*0*P*:~",
  "GS*HI*UMOPAYER*SUBMITTER*20260601*1230*1*X*005010X217~",
  "ST*278*0002*005010X217~",
  "BHT*0078*11*AUTHRESP-202606*20260601*1230~",
  "HL*1**20*1~",
  "NM1*X3*2*UTILIZATION REVIEW CO*****PI*UMO001~",
  "HL*2*1*21*1~",
  "NM1*1P*2*RENDERING CLINIC*****XX*1234567893~",
  "HL*3*2*22*1~",
  "NM1*IL*1*DOE*JANE****MI*MBR0001~",
  "DMG*D8*19850515*F~",
  "HL*4*3*EV*1~",
  "TRN*1*AUTHREQ-202606-0001*9SUBMITTER~",
  "UM*HS*I*1~",
  "HCR*A1*AUTH123456~",
  "DTP*472*RD8*20260601-20260605~",
  "HI*ABK:E1165~",
  "SE*16*0002~",
  "GE*1*1~",
  "IEA*1*000000002~",
].join("");

const ix278 = parseX12(raw278);
const tx278 = ix278.groups[0]?.transactions.find((t) => t.st.elements[1] === "278");
const review278 = tx278 ? get278Response(ix278.delimiters, tx278) : undefined;

review278?.direction; // => "response"
review278?.warnings.length; // => 0
review278?.utilizationManagementOrganization?.name; // => "UTILIZATION REVIEW CO"
review278?.subscriber?.idCode; // => "MBR0001"

const review = review278?.reviews[0];

// The trace that reassociates this answer to the request you sent.
review?.traces[0]?.referenceId; // => "AUTHREQ-202606-0001"
review?.requestCategoryCode; // => "HS"
review?.certificationTypeCode; // => "I"

// HCR-01: the certification action, verbatim, never inferred from anything else.
review?.decision?.actionCode; // => "A1"
review?.decision?.reviewIdentificationNumber; // => "AUTH123456"

// The diagnosis carries its code system, resolved from the HI qualifier.
review?.diagnoses[0]?.qualifier; // => "ABK"
review?.diagnoses[0]?.code; // => "E1165"
review?.diagnoses[0]?.codeSystem; // => "ICD-10-CM"

Before you build a 278​

Every HL-03 in this library is a library constant chosen by tree position, with a single exception: Build278ReviewSpec.levelCode, which you supply and which the guides limit to EV (patient event) and SS (service). A level outside those two emits a perfectly well-formed document whose review loop no reader opens, so the review and its certification decision would come back absent with no warning. build278Request and build278Response therefore refuse an out-of-enum level rather than emit a document that loses it. Omit levelCode and it defaults to EV.