Sending and Receiving PANotifications
1 min
Sending PANotification - Provider Vendor
- If the NewRx is released prior to receiving the PAResponse (PARequest submitted):
- Send the PANotification with status of 'R' (Requested) OR;
- Send the PriorAuthorizationStatus of 'R' in the NewRx.
- Once the PAResponse is received, send pharmacy a second PANotification with final determination status.
- If the NewRx is sent after receiving the PAResponse:
- PANotification with the final determination status can be sent OR;
- Send the PriorAuthorizationStatus in the NewRx.
- If the provider vendor receives an RxChange P and submits PARequest:
- Send the PANotification with status of 'R' (Requested) OR;
- Once the PAResponse is received, send pharmacy a PANotification with final determination status OR;
- Send the PriorAuthorizationStatus in the RxChange Response.
- If the provider vender chooses to send a PANotification alongside another transaction with PriorAuthorizationStatus, they should reflect the same status.
Receiving PANotification - Provider Vendor
It is recommended that the prior authorization status received be displayed to the end user upon receipt.
Sending PANotification - Pharmacy Software Vendor
- If the prior authorization is started using another method (fax, portal), send the prescriber a PANotification with the status of 'R' (Requested).
- If the prior auth was completed using another method (fax, portal), send the prescriber a PANotification with the final determination received.
- When sending a PANotification to a provider vendor, the RelatestoMessageID should be the MessageID of the NewRx.
Receiving PANotification - Pharmacy Software Vendor
- It is recommended that the PriorAuthorizationStatus received be displayed to the end user.
- If the pharmacy vendor has received the PriorAuthorizationStatus (in a NewRx, RxChangeResponse, or PANotification), no further action for the prior authorization is needed (additional adjudication checks, or kicking off a manual prior authorization process for that patient and medication combination.)