/
Prior Auth Segment

Prior Auth Segment

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

 

 

Related content

CoverMyMeds Setup
CoverMyMeds Setup
Read with this
Provider Segment
Provider Segment
More like this
Insurance Segment
Insurance Segment
More like this
Prescriber Segment
Prescriber Segment
More like this
Clinical Segment
Clinical Segment
More like this
© BestRx Pharmacy Software