|
Name |
Type |
Discontinued? |
|
1 |
REFERRAL_ID |
NUMERIC |
No |
|
|
|
The unique identifier for the referral record. |
|
|
2 |
LINE |
INTEGER |
No |
|
|
|
The line number for the information associated with this record. Multiple pieces of information can be associated with this record. |
|
|
3 |
EPA_STATUS_C_NAME |
VARCHAR |
No |
|
|
|
This item holds the status of the electronic prior authorization request. |
May contain organization-specific values: No |
Category Entries: |
Request sent |
Open |
Closed |
Denied |
Appeal sent |
Appeal open |
Appeal denied |
Appeal closed |
Canceled |
Waiting for manual response |
Change payer |
Approved |
Appeal approved |
Error |
In Process |
|
|
4 |
PAYER_ORG_ID |
NUMERIC |
No |
|
|
|
This item holds the payer the electronic prior authorization request was sent to. |
|
|
5 |
PAYER_ORG_ID_EXTERNAL_NAME |
VARCHAR |
No |
|
|
|
Organization's external name used as the display name on forms and user interfaces. |
|
|
6 |
PA_CASE_ID |
VARCHAR |
No |
|
|
|
This item holds the electronic prior authorization case ID. It is generated by the payer for tracking the electronic prior authorization transaction in their internal system. This value will not change during an electronic prior authorization interaction unless the payer is changed. |
|
|
7 |
PA_APPEAL_CASE_ID |
VARCHAR |
No |
|
|
|
This item holds the electronic prior authorization appeal case ID. It is generated by the payer for tracking the electronic prior authorization appeal transaction in their internal system. This value will not change during an electronic prior authorization interaction unless the payer is changed. |
|
|
8 |
ACTION_RECVD_DTTM |
DATETIME (UTC) |
No |
|
|
|
This item holds the instant that the electronic prior authorization action was received. |
|
|
9 |
ACTION_SENT_DTTM |
DATETIME (UTC) |
No |
|
|
|
This item holds the instant that the electronic prior authorization action response was sent. |
|
|
10 |
CANCEL_RSN_ID |
NUMERIC |
No |
|
|
|
This item holds the reason that the electronic prior authorization request was canceled. |
|
|
11 |
CANCEL_RSN_ID_EXT_CODE_LST_NAME |
VARCHAR |
No |
|
|
|
The name of the list value. |
|
|
12 |
E_APPEAL_SUPPORT_YN |
VARCHAR |
No |
|
|
|
This item indicates if the payer supports receiving an electronic appeal. |
May contain organization-specific values: No |
Category Entries: |
No |
Yes |
|
|
13 |
QUESN_START_LINE |
INTEGER |
No |
|
|
|
This item holds the line number of the first question associated with this electronic prior authorization action. The actual questions are stored in referral file (RFL) related group 9300. |
|
|
14 |
REPLY_DEADLINE_DT |
DATETIME |
No |
|
|
|
This item holds the deadline for replying to the electronic prior authorization questions. |
|
|
15 |
QUESN_SET_TITLE |
VARCHAR |
No |
|
|
|
This item holds the question set title. |
|
|
16 |
QUESN_PHONE_NUM |
VARCHAR |
No |
|
|
|
This item holds the phone number for the electronic prior authorization question set. |
|
|
17 |
QUESN_END_LINE |
INTEGER |
No |
|
|
|
This item holds the line number of the last question associated with this electronic prior authorization action. The actual questions are stored in referral file (RFL) related group 9300. |
|
|
18 |
PA_CANCEL_RSLT_C_NAME |
VARCHAR |
No |
|
|
|
This item holds the result of a request to cancel an ePA request. |
May contain organization-specific values: No |
Category Entries: |
Approved |
Denied |
|
|
19 |
PA_CNCL_RSLT_RSN_ID |
NUMERIC |
No |
|
|
|
This holds the code indicating why a cancel request was denied. |
|
|
20 |
PA_CNCL_RSLT_RSN_ID_EXT_CODE_LST_NAME |
VARCHAR |
No |
|
|
|
The name of the list value. |
|
|
21 |
QUESN_SET_ID |
VARCHAR |
No |
|
|
|
This item holds the ID of an electronic prior authorization question set. |
|
|
22 |
SEND_USER_ID |
VARCHAR |
No |
|
|
|
This item holds the user ID of the last user who performed an action that populated the ePA Action Instant Sent item I RFL 9206. |
|
|
23 |
SEND_USER_ID_NAME |
VARCHAR |
No |
|
|
|
The name of the user record. This name may be hidden. |
|
|
24 |
QUESN_FAX_NUM |
VARCHAR |
No |
|
|
|
This item holds the fax number for the electronic prior authorization question set |
|
|
25 |
EPA_REPLY_TM |
DATETIME (UTC) |
No |
|
|
|
Holds the time component of the deadline to reply, if available. |
|
|
26 |
EPA_RELATES_MSG |
VARCHAR |
No |
|
|
|
This holds the message ID that ePA closed responses are related to. |
|
|
27 |
EPA_CLSED_RSP_SRC_C_NAME |
VARCHAR |
No |
|
|
|
This holds the type of closed response that is stored on this line of data. |
May contain organization-specific values: No |
Category Entries: |
PBM |
3rd Party |
Network |
|
|
28 |
EPA_FORM_URL |
VARCHAR |
No |
|
|
|
This holds the URL pointing to a form to enter PA details. |
|
|
29 |
ATTACHMENT_REQ_YN |
VARCHAR |
No |
|
|
|
This item indicates whether an attachment is required as part of filling out this question set. |
The category values for this column were already listed for column: E_APPEAL_SUPPORT_YN |
|
|
30 |
EXPECT_RESP_DATE |
DATETIME |
No |
|
|
|
This item holds the date by which a response is expected from the payer. |
|
|
31 |
EPA_BEN_INFO_MESSAGE_ID |
NUMERIC |
No |
|
|
|
This item holds the ID of the interface message that holds coordination of benefits information that applies to this prior authorization request. |
|
|
32 |
EPA_ATTACHMENT_ID |
VARCHAR |
No |
|
|
|
This item holds the DCS record representing an ePA attachment. |
|
|