---
title: PAResponse (from PBM/Payer)
slug: electronic-prior-auth/guide/paresponse-from-pbmpayer
docTags:
createdAt: 2026-06-22T20:46:07.105Z
---
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
7777777
P99999999999999
8890
1234569
2014-12-02T17:05:12.1Z
ACCT_ID_INSERTED_BY_SS
ACCT_ID_INSERTED_BY_SS
MD80SYSTEM
80
15.2
77XX2
333445555
SMITH
MARY
F
1954-12-25
45 EAST ROAD SW
CLANCY
WI
54999
US
7701630
7878787878
MAIN STREET PHARMACY
6155555656
666666666
JONES
MARK
211 CENTRAL ROAD
JONESVILLE
TN
37777
US
6152219800
LOVENOX 40 MG PER 0.4 ML PREFILLED SYRINGE
100
C42945
C42576
30
38
C48540
30
1
ABF
E11.9
DIABETES MELLITUS
INJECT 40 MG SUBCUTANEOUSLY ONCE DAILY
A101
QS101-FOLLOWUP
Lovenox PA Form - Follow up question(s)
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.
5555551212
false
FOLLOWUP_Q1
1
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.
END
true
2014-10-02T23:59:59
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!
```
**PAResponse (from PBM/payer) Example Element Details**
:::hint{type="info"}
**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) |