Submit an X12 278 prior authorization request to a clearinghouse

Verified steps

1. Obtain trading partner credentials and the clearinghouse submission endpoint; confirm whether they accept X12 278 Request for Review and Response (005010X217) as a real-time or batch transaction
2. Build the ISA/GS envelope with your sender and receiver interchange IDs, then construct the 278 transaction set: begin with the HL loop hierarchy — the first HL loop is the subscriber level, followed by patient and then service event loops
3. Populate the STC, REF, DTP, NM1, and SV segments within the appropriate HL loops to describe the subscriber, patient, requesting provider, servicing provider, and the service being requested including diagnosis codes (HI segment) and procedure codes
4. Close the transaction with SE, GE, and IEA envelope trailers ensuring all segment counts and control numbers match their corresponding headers
5. Submit the X12 file via the clearinghouse's API (HTTPS POST with EDI payload or SFTP drop) using your API credentials (YOUR_TOKEN) and capture the synchronous 999 functional acknowledgment or batch acknowledgment
6. Poll for or receive the 278 response (Health Care Services Review — Response) and parse the AAA and HCR segments to determine whether authorization was approved, pended for medical review, or denied