Application Certification Requirements

for customers using electronic prior authorization accelerator, the items marked with are certified by surescripts on your behalf provider vendor requirements pa 200 the application shall make available for display the responsestatus and each occurrence of a panote from all response transactions multiple responses of the same type may be received pa 201 when the pbm/payer provides a question set in the painitiationresponse, the application shall display questionsetcontactcommunicationnumber deadlineforreply attachmentnotes (when attachment required) pa 202 the application shall require all specified questions to be answered (not blank) and an order, prior to sending the parequest pa 203 in the event that a pa has been canceled by the initiator or closed by the pbm, and the prior authorization is still desired, a new painitiationrequest shall be sent pa 204 when the prescriber and main prior authorization contact vary, the application shall utilize the provider composite to supply the prior authorization contact name and primarytelephone pa 205 provider vendors shall not send a paappealrequest if the value of the iseappealsupported field is "false" in the paresponse pa 206 prescribing vendors who are utilizing the surescripts eligibility 270/271 messages shall populate the first benefitscoordination element with the associated information returned in a surescripts 271 message if more than one active coverage is returned, only the single coverage information utilized to write the prescription is sent the 271 message's isa13 control number shall be populated in the benefitscoordination/interchangecontrolnumber field in all instances including scenarios where there is no active coverage pa 207 either medicationprescribed/dayssuppy or medicationprescribed/padayssupplydosesperday shall be populated in the painitiationrequest when available pa 208 if the painitiationrequest includes a papriorityindicator flag, the priority must be displayed to the end user the value of "s" (standard priority) should be the default if the data element is sent in the transaction pa 209 the application shall make available for display the expirationdate to the prescriber for a prior authorization renewal request (unsolicited painitiationresponse) pa 210 if a pbm/payer requires an attachment in an answered question, the application shall not allow a request to be sent without the attachment composite being populated pa 211 when both a brand and generic ndc exist for a medication, in the painitiationrequest provider vendors shall submit the drug description and ndc of the form of the medication they want to prescribe for the patient pa 214 the application shall support the epa question set conditional logic as outlined in the ncpdp epa standard pa 219 the drug name shall be an item that is currently available for dispensing if there are active ndcs available, an inactive/obsolete ndc shall not be used customers are expected to work with their drug compendia vendor to satisfy this requirement s 203 sender demographic information, when included in the message, shall match what was registered by the customer in the surescripts directory when a prescribing system utilizes the surescripts learning directory service, this requirement is satisfied for learned locations s 208 codified values within a message shall not conflict with the related textual concept example 1 field name proper use improper use drugdescription primariea 10mg/10ml liquid drugcoded/strength/strengthvalue 10 \<empty> drugcoded/strength/strengthunitofmeasure/code c42576 (mg/ml) drugcoded/strength/strengthform/code c42953 example 2 field name proper use improper use drugdescription amoxicillin 500 mg oral capsule drugcoded/strength/strengthvalue 500 250 drugcoded/strength/strengthunitofmeasure/code c28253 (milligram) c28254 (milliliter) drugcoded/strength/strengthform/code c25158 (capsule) c42998 (tablet) provider vendor and pbm/payer requirements pa 212 payer and submitter systems shall be able to send and receive pdf attachments at a minimum pa 213 participant applications shall not allow users/systems to respond multiple times to a message the application has already sent the only exceptions are the inprocess paresponse followed by an approved/denied paresponse message; and parequest/paresponses when additional information is requested pa 220 customers shall support the scenarios detailed in the message flow section of this guide s 200 customers shall be able to receive syntactically valid maximum and minimum populated messages optional data elements (and values therein) shall not cause message failure s 201 customers shall ensure all messages are syntactically correct before transmission to surescripts s 205 the sender shall ensure the combination of the from and messageid elements, for all messages including error, is unique for at least 18 months surescripts recommends an unformatted globally unique identifier (guid) s 206 system shall support user entry and display of up to three digits to the right of the decimal place, without the system rounding or truncating the decimal point is represented by a period and shall be used as follows only when there are significant digits to the right of the decimal when there is a digit before and after the decimal point not with whole numbers for example, consider the following possible values correct format examples incorrect format examples 2 5 27 0 15 3 00 21 14 s 209 the customer shall implement and maintain a surescripts approved drug compendia that is updated at least monthly pbm/payer requirements pa 215 if the pbm/health plan receives a painitiationrequest or parequest that contains a papriorityindicator of "x" (expedited), the pbm/health plan shall process the request and respond in an expedited manner if the painitiationrequest or parequest needs to be manually reviewed for priority, then the pbm/health plans shall make the priority indicator available for display pa 216 if the provider vendor populates the provider composite, the pbm system shall make the provider composite contents available to be viewed by the user pa 217 the pbm/payer system shall make available for display the questionsetcomment from the parequest and the paappealrequest if the prior authorization request would otherwise be denied or approved with modifications pa 218 the pbm/payer system shall only send one paresponse with a status of 'inprocess' and include the expectedresponsedate and/or panote this paresponse is to be followed by a subsequent paresponse with the final determination or request for additional information