---
title: Message Business Flow Response Summary
slug: electronic-prior-auth/guide/message-business-flow-response-summary
docTags:
createdAt: 2026-06-02T15:55:09.702Z
---
The following table shows details on how a customer should respond to certain business scenarios using the appropriate message type, reason code, and response text when applicable. This table does not represent all codes.
:::hint{type="info"}
**Note: **Error codes are constrained by the schema. Reason code "BY" (meaning other) should only be used when there is not a more explicit reason code available.
:::
| **Event ID** | **Event** | **Response Message Type** | **Response Status (ResponseStatus element)** | **Reason Code (Response Status: ReasonCode)** | **Standard Response Text (ResponseStatus: PANote)** | **Comments** |
| ----------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------- | -------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **PA Initiation** | **Initiation main flow: PBM/payer returns a PA question set in response to a syntactically valid PAInitiationRequest message from the provider system.** | | | | | |
| 1.1 | Provider system submits a valid PAInitiationRequest message to a PBM/payer. PBM/payer returns a question set to be completed by the prescriber. | PAInitiationResponse | Open | N/A | N/A | |
| | **Alternative flows in response to a syntactically valid PA Initiation message from the provider system.** | | | | | |
| 1.2 | Prior authorization is not needed for this patient and medication. | PAInitiationResponse | Closed | CC - Prior Authorization not required for patient/medication | | |
| 1.3 | The patient in the request not recognized by the PBM/payer. | PAInitiationResponse | Closed | CD - Cannot find matching patient | | |
| 1.4 | The patient in the request is not covered by the PBM/payer. | PAInitiationResponse | Closed | CE - Patient not eligible (does not have coverage with the PBM/payer) | | |
| 1.5 | Requested PA is a duplicate of one that has already been approved. PBM/payer responds with information about the previously submitted request. | PAInitiationResponse | Closed | CF - Prior Authorization duplicate/approved | | |
| 1.6 | Requested PA is a duplicate of another in-process request. | PAInitiationResponse | Closed | CG - Prior Authorization duplicate/in process | | |
| 1.7 | Prescriber for PA Request is not allowed to submit | PAInitiationResponse | Closed | CM - Prescriber not allowed to submit PA Request | | |
| 1.8 | The receiving PBM/payer is not the PA processor for this patient. | PAInitiationResponse | Closed | CO - The receiver is not the PA processor for this patient | The responder should include text providing information about how to contact the third-party processor, if known. | When the PBM/payer returns this reason code, Surescripts will try to determine the third-party processor for the PA and generate a 2nd PAInitiationRequest if one is found. |
| 1.9 | Prescriber for PA Request is not allowed to submit | PAInitiationResponse | Closed | CM - Prescriber not allowed to submit PA Request | | |
| 1.10 | The receiving PBM/payer does not process PA for this patient and medication combination. | PAInitiationResponse | Closed | CP - The receiver is not the PA processor for this patient and medication combination | The responder should include text providing information about how to contact the third-party processor, if known. | When the PBM/payer returns this reason code, Surescripts will generate a 2nd PAInitiationRequest to try and determine the third-party processor for the PA. |
| 1.11 | Requested PA is a duplicate of another denied request. | PAInitiationResponse | Closed | CY - Prior Authorization duplicate/denied | | |
| 1.12 | Prior Authorization is not available for this drug/product under patient’s plan. | PAInitiationResponse | Closed | FM - Product not covered by this plan. Prior Authorization not available. (Used when the drug will not be covered even if the provider does a PA) | | |
| 1.13 | Prior Authorization is not required for the prescription amount. | PAInitiationResponse | Closed | FN - Prescription within prescribing limits. Prior Authorization not required for PATIENT/MEDICATION. (Used when there are coverage rules in place, but the prescriber is not going outside of them) | | |
| 1.14 | Patient’s plan will pay for the drug up to certain coverage limits for quantity and/or days supply. | PAInitiationResponse | Closed | FO - Coverage limits may exist for quantity and/or days supply. Plan will pay up to coverage limit. Prior Authorization not required for PATIENT/MEDICATION. (Used when the plan will only pay up to a certain amount, but not above) | | If the PBM/Health Plan is going to send this, include details about the coverage limit in the PANote |
| 1.15 | Coverage limits have been exceeded and exceptions cannot be made. If prescribing within limits, PA is not required. | PAInitiationResponse | Closed | FP - Coverage limits have been exceeded, exception not available. Prior Authorization not required for PATIENT/MEDICATION when within coverage limit. | | |
| 1.16 | There is an active PA on file for this patient/medication combination. | PAInitiationResponse | Closed | FQ - Active PA on file. | | |
| 1.17 | The Product Code submitted in the PA is not valid. | PAInitiationResponse | Closed | FR - Submitted Product Code is not valid. Please resolve and resubmit. | | |
| 1.18 | The receiving PBM/payer does not support ePA in this case. | PAInitiationResponse | Closed | BX - Electronic Prior Authorization not currently supported by PBM/payer for this health plan/disease state/medication. Submit via other methods. | | BX should only be used when the PBM/payer is the prior authorization processor, but ePA is not available for that health plan or drug. |
| 1.19 | Other business exception. For example:
Version of ICD diagnosis code sent is not supported.
OR
Duplicate message, denied. | PAInitiationResponse | Closed | BY - Other not covered by other values | The responder should include text describing the exception | Surescripts will send a closed response with a reason code BY and a note: ‘Sorry but Surescripts cannot process this PA request electronically. Please refer to the original instructions from the PBM for information on how to process this prior authorization manually. |
| **PARequest** | **PARequest Main flow: PBM/payer approves the PA (Solicited ePA workflow) in response to a syntactically valid PARequest message from the provider system.** | | | | | |
| 2.1 | Provider system submits a valid PARequest message to a PBM/payer. PBM/payer returns its approval. | PAResponse | Approved | N/A | N/A | |
| | **Alternative flows: In response to a syntactically valid PARequest message from the provider system** | | | | | |
| 2.2 | Denied response | PAResponse | Denied | N/A | | |
| 2.3 | The PBM/payer requires additional information from the provider. It responds with a message containing a question set with additional questions. | PAResponse (Including another question set) | Open | N/A | | |
| 2.4a | Answer in PARequest is incomplete or invalid. PBM/payer asks again. | PAResponse (Including another question set) | Open | N/A | The responder should indicate the question at issue | |
| 2.4b | A notification that the request is in process, including the expected resolution date if known. | PAResponse | InProcess | N/A | | |
| 2.4c | A notice indicating that the prior authorization has been approved by the payer, but with some limits. These limits may include pharmacy type, quantity, days supply, number of cycles, or refills. | PAResponse | PartiallyDenied | N/A | | |
| 2.4d | Answer in PARequest is incomplete or invalid. PBM/payer closes the case. | PAResponse | Closed | CN - Response content is inconsistent with the question | The responder should indicate the question at issue. Provider needs to open a new case. | |
| 2.5a | Message attachment is valid, but the PBM/payer doesn't support the attachment type. PBM/payer requests that the provider system provide the information in a different form, using another question set. | PAResponse | Open | N/A | The PBM/payer should suggest a different way for the provider to provide the information | |
| 2.5b | Message attachment is valid, but the PBM/payer doesn't support the attachment type. PBM/payer processes the request ignoring the attachment, if it is not needed. | PAResponse | PBM/payer processes normally | PBM/payer processes normally | | |
| 2.6a | PARequest was received after the DeadlineForReply stated in the associated PAInitiationResponse message. The PBM/payer closes the PA case. | PAResponse | Closed | BY - Other not covered by other values | Message received after Deadline to Reply \[plus any additional text from the PBM/payer] | |
| 2.6b | PARequest was received after the DeadlineForReply stated in the associated PAInitiationResponse message. The PBM/payer ignores the date and processes anyway. | PAResponse | PBM/payer processes normally | PBM/payer processes normally | | |
| 2.7 | After submitting a PARequest message, but before the PBM/payer has responded with a PAResponse, the provider requests by means other than the PA Cancel Request message that their case be closed. The PBM/payer returns a PAResponse message indicating the case was closed by the provider. | PAResponse | Closed | CJ - Closed by Provider | | |
| 2.8 | After the provider submits a PARequest message, but before the PBM/payer has responded with a PAResponse, the patient contacts the PBM/payer by phone or other means and requests that the case be closed. The PBM/payer returns a PAResponse message indicating the case was closed by the member. | PAResponse | Closed | CK - Closed by Member | | |
| 2.9 | Requested PA is a duplicate of one that has already been approved. PBM/payer responds with information about the previously submitted request. | PAResponse | Closed | CF - Prior Authorization duplicate/approved | | |
| 2.10 | Requested PA is a duplicate of another in-process request. | PAResponse | Closed | CG - Prior Authorization duplicate/in process | | |
| 2.11 | PBM/payer is not able to accept the request from the prescriber identified in the PARequest message. | PAResponse | Closed | CM - Prescriber not allowed to submit PARequest | | |
| 2.12 | Other business exception. | PAResponse | Closed | BY - Other not covered by other values | The responder should include text describing the exception | |
| 2.13 | The PBM/health plan/processor closes the case for an undefined reason. | PAResponse | Closed | CH – Closed by PBM/health plan/processor | The responder should include text describing the closed reason. | |
| 2.14 | The PBM/health plan closes the case due to communication with the member. | PAResponse | Closed | CK – Closed by member | The responder should include text describing the closed reason. | |
| 2.15 | The PBM/health plan/processor does not accept the attachment type sent by the submitter. | PAResponse | Open | CL – Attachment type (MIME type) type not supported | The responder should avoid sending this reason code if possible and should instead return an Open response indicating that the originally provided attachment is not supported by the receiver. Responders may not return an error if an unsupported attachment type is received. All attachment types supported by the NCPDP ePA standard must be received without error, per ACR PA.212. | |
| 2.16 | Requested PA is a duplicate of another denied request. | PAResponse | Closed | CY - Prior Authorization duplicate/denied | | |
| 2.17 | Provider responded after deadline to reply. PA must be reinitiated. | PAResponse | Closed | FL - Provider responded after deadline to reply. PA must be reinitiated | | |
| 2.18 | Prior Authorization is not available for this drug/product under patient’s plan. | PAResponse | Closed | FM - Product not covered by this plan. Prior Authorization not available. (Used when the drug will not be covered even if the provider does a PA) | | |
| 2.19 | Prior Authorization is not required for the prescription amount. | PAResponse | Closed | FN - Prescription within prescribing limits. Prior Authorization not required for PATIENT/MEDICATION. (Used when there are coverage rules in place, but the prescriber is not going outside of them) | | |
| 2.20 | Patient’s plan will pay for the drug up to certain coverage limits for quantity and/or days supply. | PAResponse | Closed | FO - Coverage limits may exist for quantity and/or days supply. Plan will pay up to coverage limit. Prior Authorization not required for PATIENT/MEDICATION. (Used when the plan will only pay up to a certain amount, but not above) | | If the PBM/Health Plan is going to send this, include details about the coverage limit in the PANote |
| 2.21 | Coverage limits have been exceeded and exceptions cannot be made. If prescribing within limits, PA is not required. | PAResponse | Closed | FP - Coverage limits have been exceeded exception not available. Prior Authorization not required for PATIENT/MEDICATION when within coverage limit. | | |
| 2.22 | There is an active PA on file for this patient/medication combination. | PAResponse | Closed | FQ - Active PA on file. | | |
| 2.23 | The Product Code submitted in the PA is not valid. | PAResponse | Closed | FR - Submitted Product Code is not valid. Please resolve and resubmit. | | |
| **PA Appeal** | **PA Appeal Main flow: PBM/payer approves the Appeal in response to a syntactically valid PAAppealRequest message from the provider system.** | | | | | |
| 3.1 | Provider system submits a valid PAAppealRequest message to a PBM/payer. PBM/payer returns its approval. | PA Appeal Response | Approved | N/A | N/A | |
| | **Alternative flows in response to a syntactically valid PA Appeal message from the provider system** | | | | | |
| 3.2 | Denied response. PBM/payer returns its denial. | PA Appeal Response | Denied | N/A | | |
| 3.3 | PBM/payer requests additional information. PBM/payer returns a request for additional information (by including a question set in its response). | PA Appeal Response | Open | N/A | | |
| 3.4a | Answer in PA Appeal Request is incomplete or invalid. PBM/payer asks again. | PA Appeal Response (Including another question set) | Open | N/A | The responder should indicate the question at issue | |
| 3.4b | Answer in PA Appeal Request is incomplete or invalid. PBM/payer closes the case. | PA Appeal Response | Closed | CN - Response content is inconsistent with the question | The responder should indicate the question at issue | |
| 3.5 | The provider submits a PA Appeal Request for a case where electronic appeal is not available. The PBM/payer notifies the provider system that electronic appeal is not available for this case. | PA Appeal Response | Closed | BY - Other not covered by other values | Electronic appeals are not supported for this case \[plus any additional text from the PBM/payer] | |
| 3.6a | PA Appeal Request was received after the DeadlineForReply stated in an earlier PAAppealResponse message. The PBM/payer closes the PA appeal case. | PA Appeal Response | Closed | BY - Other not covered by other values | Message received after Deadline to Reply \[plus any additional text from the PBM/payer] | |
| 3.6b | PA Appeal Request was received after the DeadlineForReply stated in an earlier PAAppealResponse message. The PBM/payer ignores the date and continues to process. | PA Appeal Response | PBM/payer processes normally | PBM/payer processes normally | | |
| 3.7 | After the provider submits a PARequest message, the patient contacts the PBM/payer by phone or other means and requests that the case be closed. The PBM/payer returns a PA Appeal Response message indicating the case was closed by the member. | PA Appeal Response | Closed | CK - Closed by Member | | |
| 3.8 | Requested PA is a duplicate of one that has already been approved. PBM/payer responds with information about the previously submitted request. | PA Appeal Response | Closed | CF - Prior Authorization duplicate/approved | | |
| 3.9 | Requested PA is a duplicate of another in-process request. | PA Appeal Response | Closed | CG - Prior Authorization duplicate/in process | | |
| 3.10 | PBM/payer is not able to accept the request from the prescriber identified in the PARequest message. | PA Appeal Response | Closed | CM - Prescriber not allowed to submit PARequest | | |
| 3.11 | Other business exception. | PA Appeal Response | Closed | BY - Other | The responder should include text describing the exception | |
| 3.12 | The PBM/payer/health plan/processor closes the case for an undefined reason. | PA Appeal Response | Closed | CH - Closed by PBM/health plan/processor | The responder should include text describing the closed reason. | |
| 3.13 | The PBM/payer/health plan/processor does not accept the attachment type sent by the submitter. | PA Appeal Response | Open | CL - Attachment type (MIME) type not supported | The responder should not send this reason code. All attachment types supported by the NCPDP ePA standard must be received without error, per ACR PA.212. | |
| **PA Cancel** | **PA Cancel Main flow: PBM/payer successfully cancels the PA case in response to a syntactically valid PACancelRequest message from the provider system** | | | | | |
| 4.1 | Provider system submits a valid PACancelRequest message to a PBM/payer. PBM/payer returns its approval of the PA Cancel Request. | PA Cancel Response | Approved | N/A | N/A | |
| | **Alternative Flows in response to a syntactically valid PACancelRequest message from the provider system** | | | | | |
| 4.2 | PA Case ID was not found by the PBM/payer. | PA Cancel Response | Denied | BZ - Can’t find PACaseID | | |
| 4.3 | The PBM/payer is unable to locate a case matching the submitted Case ID and patient information. | PA Cancel Response | Denied | CA - Unable to locate based on insufficient information/identifiers do not match | | |
| 4.4 | The provider submits a PA Cancel Request for a case that has already been determined. | PA Cancel Response | Denied | CB - Request already processed/final determination has been made | | |
| 4.5 | Other business exception. | PA Cancel Response | Denied | BY - Other not covered by other values | The responder should include text describing the exception | |