X12 278 and FHIR together

Two languages, one request

Prior authorization has long used an older electronic standard called X twelve two seven eight. FHIR is the newer way. This lesson explains how the two live side by side.

FHIR in, X12 out

The P A S guide was written so that the older standard still has a place. The provider's system speaks FHIR. The receiving system converts the FHIR Bundle into the X twelve two seven eight transaction when needed, and passes it on. The answer is converted back into FHIR on the way home. The guide treats everything beyond that endpoint as a black box.

• EHR system
• FHIR request
• Payer system · building
• X12 278 · file

All-FHIR is allowed

HIPAA names X twelve two seven eight as the standard for prior authorization. The C M S fact sheet says HHS would use enforcement discretion. A covered entity that implements an all FHIR prior authorization A P I, without X twelve two seven eight, will not be enforced against under HIPAA administrative simplification. So FHIR only, or FHIR and X twelve together, is allowed. Covered entities may also offer an X twelve only transaction.

Check yourself

Pause and think. What may a covered entity use for its Prior Authorization A P I? The answer: FHIR only, or FHIR and X twelve together.

• FHIR only, or FHIR and X12 together
• Fax only
• X12 only, never FHIR
• Email only

Keep these in mind

X twelve two seven eight is the older prior authorization standard. An intermediary can convert FHIR to X twelve and back. All FHIR A P Is are allowed under enforcement discretion. And X twelve only may still be offered.

• X12 278 is the older prior authorization standard
• An intermediary can convert FHIR to X12 and back
• All-FHIR APIs are allowed under enforcement discretion
• X12-only may still be offered