PAAppealRequest Elements
Element | Code | Comments |
|---|---|---|
Request | mandatory | |
PACaseID | mandatory | PBM/payer-assigned identifier for the PA that is being appealed. |
AppealCaseID | conditional | Only returned in an PAAppealResponse if there are additional questions. If returned by PBM/payer, provider vendors should include in subsequent PAAppealRequest messages. |
DeadlineForReply | conditional | If the PBM/payer returns a question set in their PAAppealResponse, the subsequent PAAppealRequest must be returned by this date/time. |
QuestionSet | conditional | If the PBM/payer returns a Question Set in their PAAppealResponse, the subsequent PAAppealRequest would contain the question set and associated answers. |
PANote | conditional | Free text note describing reason for the appeal. Note: Some PBM/payers may approve or deny appeal requests solely based on PANote. If this field is not included in the first PAAppealRequest, some PBM/payers may deny the appeal. |