HITSP Patient Health Plan Authorization Request and Response Transaction

July 8, 2009

Version 1.1

HITSP Patient Health Plan Authorization Request and Response

HITSP/T68

Healthcare Information Technology Standards Panel (HITSP) logo

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Administrative and Financial Domain Technical Committee

Document Change History

Version Number	Description of Change	Name of Author	Date Published
	Template Updated to V2.4	Project Team	July 31, 2008
0.0.1	Review Copy	Administrative and Financial Domain Technical Committee	September 26, 2008
0.0.2	Review Copy	Administrative and Financial Domain Technical Committee	December 10, 2008
1.0	Released for Implementation	Administrative and Financial Domain Technical Committee	December 10, 2008
	Template V2.5	Project Team	June 30, 2009
1.0.1	Review Copy	Administrative and Financial Domain Technical Committee	June 30, 2009
1.1	Released for Implementation	Administrative and Financial Domain Technical Committee	July 8, 2009

Table of Contents

1.0 Introduction. 5

1.1 Overview. 5

1.2 Copyright Permissions. 5

1.3 Reference Documents. 5

1.4 Conformance. 6

1.4.1 Conformance Criteria. 6

1.4.2 Conformance Scoping, Subsetting and Options. 6

2.0 Transaction Definition. 7

2.1 Context Overview. 7

2.1.1 Transaction Constraints. 7

2.1.2 Interfaces. 8

2.1.3 Interface Interactions. 8

2.1.4 Pre-conditions. 9

2.1.4.1 Process Triggers. 9

2.1.5 Post-conditions. 9

2.1.5.1 Required Output 9

2.1.6 Data Flows. 9

2.2 List of HITSP Constructs. 15

2.2.1 Construct Dependencies. 15

2.2.2 Additional Constraints on Required Constructs. 15

2.3 Standards. 15

2.3.1 Regulatory Guidance. 15

2.3.2 Selected Standards. 15

2.3.3 Informative Reference Standards. 16

3.0 Appendix. 17

4.0 Document Updates. 18

4.1 December 10, 2008. 18

4.2 December 18, 2008. 18

4.3 June 30, 2009. 18

Figures and Tables

Figure 2-1 Authorization Flow Diagram.. 8

Table 1-1 Reference Documents. 6

Table 2-1 Transaction Constraints. 7

Table 2-2 Interfaces. 8

Table 2-3 Interface and Transaction/Content Constraints. 8

Table 2-4 Pre-conditions. 9

Table 2-5 Process Triggers. 9

Table 2-6 Post-conditions. 9

Table 2-7 Required Output 9

Table 2-8 X12N 278 Request for Review Data Mapping and Response Data Mapping. 11

Table 2-9 X12N 278 Response to Request for Review Data Mapping. 13

Table 2-10 List of HITSP Constructs. 15

Table 2-11 Construct Dependencies. 15

Table 2-12 Additional Constraints on Required Constructs. 15

Table 2-13 Regulatory Guidance. 15

Table 2-14 Selected Standards. 15

Table 2-15 Informative Reference Standards. 16