Root Level PARequest Elements

element code comments parequest 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 payeridentification conditional payerid conditional surescripts participant id assigned to the pbm/payer processoridentificationnumber conditional the pcn associated to the patient’s benefit iinnumber conditional the iin associated to the patient’s benefit mutuallydefined conditional the 271 message’s isa13 control number payername conditional pbm/payer name cardholderid conditional assigned cardholder id for the patient note pbm/payers may validate patients based on cardholder id cardholdername conditional cardholder name note pbm/payers may validate patients based on cardholder name groupid conditional id number identifying the health plan group groupname conditional name of the health plan group 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 recommended to not send 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 prescriber note the prescriber relates to the person requesting the prior authorization identification mandatory some pbm/payers may validate prescriber data against nppes or other prescriber directories using the fields under identification npi mandatory npi of the prescriber 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 drug description docid\ yqvpce3cfxk5qb1xigzwu 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\ twln8r1xlyq7syku4ornj 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 provider identification conditional npi mandatory npi of the initiating party name mandatory initiating party’s name see acr pa 204 in the application certification requirements docid\ s0azhqcpqwqhk9l9dqi1r section for more information communicationnumbers mandatory primarytelephone mandatory initiating party’s phone number see acr pa 204 in the application certification requirements docid\ s0azhqcpqwqhk9l9dqi1r section for more information fax conditional initiating party’s fax number