PAResponse Elements

element code comments paresponse pareferenceid mandatory assigned by the prescribing system on the initial message and is used as a tracking identifier on all request and response prior authorization messages to tieback related prior authorization messages the identifier must be unique per prescribing system for at least 18 months note pareferenceid shall be established with the parequest when responding to a prior authorization renewal request (unsolicited painitiationresponse) benefitscoordination pbmmemberid conditional pbm/payer assigned member id for the patient patient note refer to the schema for a complete list of fields identification conditional socialsecurity conditional patient’s social security number genderandsex mandatory values m male f female u not specified or unknown n non binary an umbrella term for people with gender identities that fall somewhere outside of the traditional conceptions of strictly either female or male pregnancyindicator conditional code indicating the patient as pregnant or non pregnant pharmacy identification mandatory ncpdpid mandatory ncpdp provider id number of pharmacy npi mandatory national provider id of pharmacy buisnessname mandatory name of pharmacy communicationnumbers mandatory phone number of pharmacy prescriber note the prescriber relates to the person requesting the prior authorization identification mandatory npi mandatory npi of the prescriber communicationnumbers mandatory prescriber’s phone number medicationprescribed drugdescription mandatory drug name (full drug name, strength, and form) for a compound, the names of the ingredients in the compound or the prescriber’s preferred name should be communicated here see drugdescription docid 3rte j4sqyuy ywhpoil best practices section for more information drugcoded conditional ndc mandatory the ndc must be a valid 11 digit code and should meet the qualifications for a representative ndc productcode conditional product identifier the representative ndc is recommended unless the message contains quantity code list qualifier “cf” or the compoundinformation element is present see ndc codes docid 3rte j4sqyuy ywhpoil for more information strength conditional strengthform/code conditional must be a valid fmt code see codified field usage for federal medication terminologies (fmt) codes docid\ b72tynfwse2b mcsxlvhl for details strengthunitofmeasure/code conditional must be a valid fmt code see codified field usage for federal medication terminologies (fmt) codes docid\ b72tynfwse2b mcsxlvhl for details quantity mandatory quantityunitofmeasure mandatory must be a valid fmt code see codified field usage for federal medication terminologies (fmt) codes docid\ b72tynfwse2b mcsxlvhl for details padayssupplydoseperday conditional medicationprescribed/dayssupply or padayssupply and padosesperday must be a whole number just one of these fields need to be submitted note in order to allow pbm/payers to provide the most accurate response, provider vendors should include dayssupply for the requested medication within painitiationrequests pbm/payers use days supply in order to determine if prescribers are requesting a quantity outside of the plan limit failure to provide days supply could result in unnecessary question sets being returned to prescribers or additional work diagnosis conditional provider vendors should send the valid version of diagnosis codes in the painitiationrequest sending diagnosis codes may speed up the process note if sending icd 10 codes (qualifier abf), sending systems should not include decimal codes for message/submission clinicalinformationqualifier mandatory qualifier for how the diagnosis was obtained values 1 prescriber/prescriber supplied 2 pharmacy inferred 3 patient 4 other source qualifier mandatory defines the code list used for the diagnosis code value mandatory code for the diagnosis description mandatory description of the diagnosis code sig conditional sigtext mandatory sigtext will be used to convey patient instructions for use or administration and should be constructed and transmitted in a patient friendly manner sigs should not be truncated because important information can be lost