Automatically Initiating ePA for RxChange Messages
1 min
RxChange messages can be sent from the pharmacy to request changes to a received prescription. If an RxChange Type P is received and no PA has been initiated, then it should be automatically done. The RxChange response should be sent after a final determination has been received.
If an RxChange Type is received and the PA is in progress, the PriorAuthorizationStatus of the RxChange response should reflect the status.
Please be aware of the following:
- If eligibility information is less than 72 hours old, provider vendors should include all benefit information from the original Eligibility Response (271) that is listed in the Sending Prior Authorization Initiation RequestsSending Prior Authorization Requests section.
- If eligibility information is more than 72 hours old, provider should send a new eligibility request for purposes of populating the BenefitsCoordination segment of the PAInitiationRequest.