***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