---
title: Element Details
slug: epa-accelerator/guide/element-details
docTags:
createdAt: 2026-08-12T17:40:19.688Z
---
# Requirement Designation
## Element Attributes:
| **Code** | **Description** |
| --------------- | -------------------------------------------------------------------------------------------------------------------------------- |
| mandatory | The element must be used per the specification (e.g., XML schema validation). |
| conditional | The element is to be used per the conditions specified. |
| business rule | If sent, the element must be used per the Surescripts business rule.
**Note**: Not all business rules reside in this table. |
| recommended | Surescripts recommends sending the element as a best practice. |
| optional | Some fields do not have specific conditions. Data should be sent if available. |
| not used | Not used by Surescripts. |
:::hint{type="info"}
This guide includes data elements only where Surescripts has specific requirements or further explains the field usage. Refer to the schema for a complete list of fields.
:::
# Element Tables
## Message Header Elements
| **Element** | **Code** | **Comments** |
| ----------------------- | ------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| To | mandatory | The identification of the intended receiver of the message.
This field contains the identification number of the recipient.
For all PAInitiationRequests, this field contains EPAINI. For all subsequent Request messages, it will contain the Participant ID of the PBM/payer/third-party processor.
For Response messages, this field contains the SPI of the provider vendor. |
| @Qualifier | conditional | business rule
If the To field is sent, then the Qualifier must also be sent.
Values:
**D** = Prescriber ID (Used for SPI)
**PY** = Payer (PBM/payer or third-party processor Participant ID)
**ZZZ** = Mutually Defined (used when sending to EPAINI) |
| From | mandatory | The identification of the sender of the message.
This field contains the identification number of the sender.
This field contains the SPI (Surescripts Provider ID) of the provider vendor, the Participant ID of the PBM/payer or third-party processor, or EPAINI. |
| @Qualifier | conditional | business rule
If the From field is sent, then the Qualifier must also be sent.
Values:
**D** = Prescriber ID (Used for SPI)
**PY** = Payer (PBM/payer or third-party processor Participant ID)
**ZZZ** = Mutually Defined (only used when Surescripts is responding from EPAINI) |
| MessageID | mandatory | The sender should ensure the combination of the From and MessageID elements is unique for at least 18 months. Surescripts recommends an unformatted Globally Unique Identifier (GUID). |
| RelatesToMessageID | conditional | Relates to Message ID is required by Surescripts. This field is the MessageID of the most recent and relevant message in the workflow, including outside of only ePA conversational messaging.
This is required for PAInitiationRequest, PAInitiationResponse, PARequest, PAResponse, PAAppealRequest, PAAppealResponse, PACancelRequest, PACancelResponse, Error, Verify, and Status. |
| SentTime | mandatory | Date of the transmission. Please see [UTC Time Format](https://docs.surescripts.com/epa-accelerator/guide/integration-and-production#utc-time-format) section. |
| SenderSoftware | mandatory | Identifies the entity responsible that generated the message. Contains the software vendor name, product, and version/release.
These fields were previously blocked by Surescripts when passing the message on to the receiver. They will now be passed on to the receiver. |
| SenderSoftwareDeveloper | mandatory | Identifies the entity responsible for the software that generated the message. The developer may be a software vendor or, if the software was developed "in-house", the developer is the entity actually sending the message (e.g., a chain). The value transmitted is determined by the Sender Software Developer. |
| SenderSoftwareProduct | mandatory | The text field that identifies the software developer’s product, as determined by the software developer. |
| SoftwareVersionRelease | mandatory | The text field that identifies the version and release of the software product, as determined by the software developer. |
| TestMessage | conditional | When sent, allowable values must match platform that message is being sent to.
Values:
**1** = Test (Required in staging environment)
All other values = Live (Production)
Surescripts does not recommend sending this field within the production environment. |
| Message Indicator Flag | conditional | Not applicable to prior authorization transactions. |
| ISA13 | conditional | This is the Interchange Control Number ISA13 value from the Eligibility response X12 271 transaction. |
## PAInitiationRequest Elements
:::hint{type="info"}
Refer to the schema for a complete list of fields, including details for PAInitiationResponse elements.
:::
| **Element** | **Code** | **Comments** |
| ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- |
| **PAInitiationRequest**
**Note:** It is recommended to populate as many conditional elements as possible to maximize the prior authorization experience. | | |
| 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). |
| PAPriorityIndicator | recommended | Indicates the requested PA processing priority. If PAPriorityIndicator is not populated, standard priority will be assumed.
Values:
**S** - Standard Priority
**X** - Urgent/Expedited Priority
**Note:** This value should be echoed on subsequent transactions. The priority may also be changed on the PARequest if the provider feels that the patient's health is at risk. |
| **BenefitsCoordination**
Note: The fields below may be returned in the Eligibility Response (271). If a PBM/payer returns active coverage, these fields should be populated with the returned value. See Benefits Coordination table in [Sending Prior Authorization Initiation Requests](docId\:f_ScGlkO2H5CdrO_Le8w0) for details on how the 271 response should be mapped to 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 | mandatory | Usage requirements:
- If patient identification data exists, include the Identification element and populate its child elements.
- If no patient identification data is available, include the Identification element but leave it empty (no child elements). |
| SocialSecurity | conditional | Patient’s Social Security Number. Not recommended to send unless explicitly required by a specific business or regulatory process. |
| 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**. |
| Address | mandatory | Parent element for patient address information. |
| AddressLine1 | mandatory | Patient’s primary address line. |
| CIty | mandatory | Patient’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| **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. |
| Name | mandatory | Surescripts may update Prescriber/Name/FirstName and Prescriber/Name/LastName with data from the Surescripts Directory in PAInitiationRequest messages prior to sending them to PBM/payers. |
| Specialty | mandatory | Surescripts may update Prescriber/Specialty with data from the Surescripts Directory in PAInitiationRequest messages prior to sending them to PBM/payers. |
| Address | mandatory | Parent element for prescriber address information. |
| AddressLine1 | mandatory | Prescriber’s primary address line. |
| CIty | mandatory | Prescriber’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| **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 DrugDescription 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](https://docs.surescripts.com/epa-accelerator/guide/best-practices#ndc-codes) for more information. |
| Strength | conditional | |
| StrengthForm/Code | conditional | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](https://docs.surescripts.com/epa-accelerator/guide/element-details#codified-field-usage-for-federal-medication-termin) for details. |
| StrengthUnitOfMeasure/Code | conditional | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](https://docs.surescripts.com/epa-accelerator/guide/element-details#codified-field-usage-for-federal-medication-termin) for details. |
| Quantity | mandatory | |
| QuantityUnitOfMeasure | mandatory | Must be a valid FMT code. See [Codified Field Usage for Federal Medication Terminologies (FMT) Codes](https://docs.surescripts.com/epa-accelerator/guide/element-details#codified-field-usage-for-federal-medication-termin) 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.
Surescripts may parse the SIG text field and use results to populate the DaysSupply field when it is not sent in a PAInitiationRequest message prior to sending to the PBM/payer. |
| 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**
**Note:** The provider loop can offer additional contacts beyond the prescriber if there were follow up questions to the PAInitiationRequest. | | |
| 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:-WS6g9UEK88h4vx9_6zxI) section for more information. |
| CommunicationNumbers | mandatory | |
| PrimaryTelephone | mandatory | Initiating party’s phone number. See ACR PA.204 in the [Application Certification Requirements](docId:-WS6g9UEK88h4vx9_6zxI) section for more information. |
| Fax | conditional | Initiating party’s fax number. |
| Address | mandatory | Parent element for provider address information. |
| AddressLine1 | mandatory | Provider’s primary address line. |
| CIty | mandatory | Provider’s city. |
| StateProvince | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
| PostalCode | conditional | Changed from **Mandatory** in v2017071 to **Conditional**. Recommended for optimal EPA experience. |
# Codified Field Usage for Federal Medication Terminologies (FMT) Codes
For a list of FMT codes, go to: [http://evs.nci.nih.gov/ftp1/NCPDP/About.html](http://evs.nci.nih.gov/ftp1/NCPDP/About.html). Use the valid value from the appropriate row of the downloaded data. This list should be updated on a monthly basis.
The table below includes some example fields.
| **Codified Field/Field Code** | **Comment** |
| ----------------------------- | --------------------------------------------------------------------------------------------------------------------- |
| StrengthForm/Code | Use the NCPDP StrengthForm Terminology rows from the downloaded data. This list should be updated on a monthly basis. |
| StrengthUnitOfMeasure/Code | Use the NCPDP StrengthUnitOfMeasure Terminology rows from the downloaded data. |
| QuantityUnitOfMeasure/Code | Use the NCPDP QuantityUnitOfMeasure Terminology rows from the downloaded data. |
| DoseUnitOfMeasure/Code | Use the NCPDP DoseUnitOfMeasure Terminology rows from the downloaded data. |
| DEASchedule | Use the NCPDP DEASchedule Terminology rows from the downloaded data. |