PAResponse (from PBM/Payer)
2 min
the pbm/payer reviews the prescriber’s parequest and determines that it needs additional information the pbm/payer returns a paresponse containing another question set with one follow up question \<?xml version="1 0" encoding="utf 8"?> \<message datatypesversion="20230115" transportversion="20230115" transactiondomain="script" transactionversion="20230115" structuresversion="20230115" eclversion="20230115"> \<header> \<to qualifier="d">7777777\</to> \<from qualifier="py">p99999999999999\</from> \<messageid>8890\</messageid> \<relatestomessageid>1234569\</relatestomessageid> \<senttime>2014 12 02t17 05 12 1z\</senttime> \<security> \<sender> \<tertiaryidentification>acct id inserted by ss\</tertiaryidentification> \</sender> \<receiver> \<tertiaryidentification>acct id inserted by ss\</tertiaryidentification> \</receiver> \</security> \<sendersoftware> \<sendersoftwaredeveloper>md80system\</sendersoftwaredeveloper> \<sendersoftwareproduct>80\</sendersoftwareproduct> \<sendersoftwareversionrelease>15 2\</sendersoftwareversionrelease> \</sendersoftware> \</header> \<body> \<paresponse> \<pareferenceid>77xx2\</pareferenceid> \<benefitscoordination> \<pbmmemberid>333445555\</pbmmemberid> \</benefitscoordination> \<patient> \<humanpatient> \<names> \<name xmlns\ xsi="http //www w3 org/2001/xmlschema instance"> \<lastname>smith\</lastname> \<firstname>mary\</firstname> \</name> \</names> \<genderandsex> \<administrativegender>f\</administrativegender> \</genderandsex> \<dateofbirth> \<date>1954 12 25\</date> \</dateofbirth> \<address> \<addressline1>45 east road sw\</addressline1> \<city>clancy\</city> \<stateprovince>wi\</stateprovince> \<postalcode>54999\</postalcode> \<countrycode>us\</countrycode> \</address> \</humanpatient> \</patient> \<pharmacy> \<identification> \<ncpdpid>7701630\</ncpdpid> \<npi>7878787878\</npi> \</identification> \<businessname>main street pharmacy\</businessname> \<communicationnumbers> \<primarytelephone> \<number>6155555656\</number> \</primarytelephone> \</communicationnumbers> \</pharmacy> \<prescriber> \<nonveterinarian> \<identification> \<npi>666666666\</npi> \</identification> \<names> \<name xmlns\ xsi="http //www w3 org/2001/xmlschema instance"> \<lastname>jones\</lastname> \<firstname>mark\</firstname> \</name> \</names> \<address> \<addressline1>211 central road\</addressline1> \<city>jonesville\</city> \<stateprovince>tn\</stateprovince> \<postalcode>37777\</postalcode> \<countrycode>us\</countrycode> \</address> \<communicationnumbers> \<primarytelephone> \<number>6152219800\</number> \</primarytelephone> \</communicationnumbers> \</nonveterinarian> \</prescriber> \<medicationprescribed> \<drugdescription xmlns\ xsi="http //www w3 org/2001/xmlschema instance">lovenox 40 mg per 0 4 ml prefilled syringe\</drugdescription> \<product> \<nondrugcoded> \<strength> \<strengthvalue>100\</strengthvalue> \<strengthform> \<code>c42945\</code> \</strengthform> \<strengthunitofmeasure> \<code>c42576\</code> \</strengthunitofmeasure> \</strength> \</nondrugcoded> \</product> \<quantity> \<value>30\</value> \<codelistqualifier>38\</codelistqualifier> \<quantityunitofmeasure> \<code>c48540\</code> \</quantityunitofmeasure> \</quantity> \<dayssupply>30\</dayssupply> \<diagnosis> \<clinicalinformationqualifier>1\</clinicalinformationqualifier> \<qualifier>abf\</qualifier> \<value>e11 9\</value> \<description>diabetes mellitus\</description> \</diagnosis> \<sig> \<sigtext>inject 40 mg subcutaneously once daily\</sigtext> \</sig> \</medicationprescribed> \<response> \<responsestatus> \<open> \<pacaseid>a101\</pacaseid> \<moreinformationrequired> \<header> \<questionsetid>qs101 followup\</questionsetid> \<questionsettitle>lovenox pa form follow up question(s)\</questionsettitle> \<questionsetdescription>thank you for your request the additional information identified here is required to finish processing the case please provide at your earliest convenience; the case will remain open until the date specified in this message \</questionsetdescription> \<questionsetcontactcommunicationnumber> \<primarytelephone> \<number>5555551212\</number> \</primarytelephone> \</questionsetcontactcommunicationnumber> \<attachmentrequired>false\</attachmentrequired> \</header> \<question> \<questionid>followup q1\</questionid> \<sequencenumber>1\</sequencenumber> \<questiontext>describe result of warfarin use (include inr and date drawn) or reason why patient can't use warfarin you may attach supporting information in a pdf document \</questiontext> \<defaultnextquestionid>end\</defaultnextquestionid> \<questiontype> \<freetext> \<isfreetext>true\</isfreetext> \</freetext> \</questiontype> \</question> \<deadlineforreply> \<datetime>2014 10 02t23 59 59\</datetime> \</deadlineforreply> \</moreinformationrequired> \<panote>we currently cannot process cda documents please answer this question regarding the patient's previous use of warfarin either by entering free text or by attaching a pdf document thank you!\</panote> \</open> \</responsestatus> \</response> \</paresponse> \</body> \</message> paresponse (from pbm/payer) example element details note the table below does not explain every element displayed in the xml example element value note to 77777777\ d id of the prescriber; d is the qualifier for a prescriber id from p99999999999999\ py id of the sending pbm/payer; py means it is the payer messageid 8890 pbm/payer system trace number for the transmission echoed back in the response message in relatestomessageid relatestomessageid 1234569 used to link the most recent message received from a trading partner in the conversation to this subsequent message senttime 2014 12 02t17 05 12 1z date and time message was sent 12/02/2014 17 05 12 1 pm paresponse paresponse message type sendersoftwaredeveloper, sendersoftwareproduct, sendersoftwareversionrelease md80system 80 15 2 sender software developer md80system sender software product 80 sender software version release 15 2 prescriberordernumber not sent not applicable rxreferencenumber not sent not applicable pareferenceid 77xx2 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) pbmmemberid 333445555 pbm/payer assigned member id for the patient socialsecurity 333445555 patient’s social security number lastname, firstname smith\ mary patient’s name gender f patient's gender dateofbirth 1954 12 25 patient’s date of birth address 45 east road sw, clancy, wi, 54999 patient’s address ncpdpid 7701630 ncpdp provider id number of pharmacy npi 7878787878 national provider id of pharmacy storename main str name of pharmacy communicationnumber 6155555656 phone number of pharmacy npi 666666666 npi of the prescriber lastname, firstname jones\ mark prescriber’s name address 211 central road, jonesville, tn, 37777 prescriber’s address communicationnumber 6152219800 prescriber’s phone number drugdescription lovenox 40 mg per 0 4 ml prefilled syringe drug prescribed is lovenox 40 mg per 0 4 ml prefilled syringe strength 100 100 is the strength strengthform c42945 c42945 is the code for "injectable solution" strengthunitofmeasure c42576 c42576 is the code for "milligrams per milliliter" quantity 30 38 quantity is 30 38 is the code value for original qty quantityunitofmeasure c48540 c48540 is the code for "syringe" dayssupply 30 30 is the number of days supply diagnosis code e11 9 e11 9 is the diagnosis code for diabetes mellitus sigtext inject 40 mg subcutaneously once daily inject 40 mg subcutaneously once daily is the sig response pacaseid a101 pbm/payer assigned identifier for this request responsestatus open deadlineforreply 2014 10 02t23 59 59 deadline for responding to this case in datetime format questionset questionset a question set is included in the pbm/payer’s response header questionsetid qs101 followup pbm/payer assigned id for this question set questionsettitle lovenox pa form follow up question(s) title of the question set, "lovenox pa form follow up question(s)" can be presented to the end user questionsetdescription thank you for your request the additional information identified here is required to finish processing the case please provide at your earliest convenience; the case will remain open until the date specified in this message instructions for the end user questionsetcontactphonenumber 5555551212 contact phone number at the pbm/payer for questions related to this pa process attachementrequired n question 1 question questionid followup q1 pbm/payer assigned id for this question questiontext describe result of warfarin use (include inr and date drawn) or reason why patient can’t use warfarin you may attach supporting information in a pdf document question text to be displayed to the end user defaultnextquestionid end last question in the question set sequencenumber 1 order of this question relative to other questions in this question set isfreetext y indicates this is a free text question (yes)