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| Table of Contents |
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| Info |
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This segment is utilized for Illinois Public Aid Prior Authorizations only. |
Field # | Field Name | Possible Value or Explanation of Field |
498-PA | Request Type | Indicates the request type for the prior authorization, 1 - Initial, 2 - Reauthorization, 3 - Deferred; located on the Prior Authorization tab off the main processing screen |
498-PB | Begin Date | Indicates when the prior authorization should begin, converted from date into YYYYMMDD format; located on the Prior Authorization tab off the main processing screen |
498-PC | End Date | Indicates when the prior authorization should end, converted from date into YYYYMMDD format; located on the Prior Authorization tab off the main processing screen |
498-PD | Basis of Request | ME- Medical Exception, PR- Plan Requirement, PL- Increase Plan Limitation; located on the Prior Authorization tab off the main processing screen |
498-PP | Supporting Documentation | Free text field based on the Diagnosis Description and Note area; located on the Prior Authorization tab off the main processing screen |
503-F3 | Authorization Number | Will display a number if the prior authorization was approved and an Auth Number issued; displayed on the Prior Authorization tab off the main processing screen |