--- title: PAResponse Elements slug: electronic-prior-auth/guide/paresponse-elements docTags: createdAt: 2026-06-18T17:59:29.971Z --- | **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. |