RQA^I11
RQA/RPA - Request for cancellation of an authorization
Patient Referral
This event may trigger the cancellation of an authorization. It may be used by the provider to indicate that an authorized service was not performed, or perhaps that the patient changed to another provider. A payor may use this request to reject a submitted authorization request from a provider.
Message Types
Message Type
Trigger Structure
Return Structure
Event Flow
TriggerI11
SendRQA_I08
ReceiveRPA_I08
Worked Examples
11.6.4 REF message using an I11 event with an immediate response
Once pre-authorization has been received, the patient is referred to the referral provider. In the following example, Dr. Blake is referring Cary Joe Brown to Dr. Jose Jimenez for a colonoscopy. The referral message includes the patient's demographic information, diagnosis and the pre-authorization information retrieved during the previous transaction. The dates contained in the pre-authorization segment (e.g., authorization date and authorization expiration date) pertain to the authorization, given by a payor, for a specified procedure. They are not intended to imply any kind of schedule request. Scheduling will be handled by the referral provider and the patient in a separate transaction. Not all referrals will require a detailed chain of response messages, so in this case, a simple acknowledgment in the form of an RPI is returned with a note from the referred-to provider.
HL7 v2
MSH|^~\&|BLAKEMD|EWHIN|JIME|EWHIN|19940111113142||REF^I11|BLAKEM7899|P|2.3.1|||NE|AL
RF1||R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA^99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703| BROWN*CJ4298^WA
NK1|1|BROWN^KATHARINA^LOU|2|N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801
GT1|1||BROWN^CARY^JOE||N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801|(509)466-0396|19600309|M||1|402941703|||| WISMER*MARTIN|||456789|01
IN1|1|PPO|WA02|WSIC (WA State Code)|11223 FOURTH STREET^^MEAD^WA^99021^USA|ANN MILLER|509)333-1234|987654321||||19901101||||BROWN^CARY^JOE|1|19600309|N. 12345 SOME STREET^^MEAD^WA^99021^USA|||||||||||||||||402941703||||||01|M
ACC|19940105125700|WR|WISMER*MARTIN
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|WA02|WSIC (WA State Code)|19940110|19940510|123456789|175|1
MSH|^~\&|JIME|EWHIN|BLAKEMD|EWHIN|19940111152401||RRI^I11|JIME1123|P|2.3.1|||ER|ER
MSA|AA|BLAKEM7899
RF1|A|R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA^99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703| BROWN*CJ4298^WA
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940111141509|00
NTE|||Patient is doing well.~Full recovery expected.11.6.5 REF message using an I11 event with a deferred response
The following example demonstrates the ability of the referral provider to return a series of responses. For most referrals, multiple responses will be returned because referrals may contain multiple requested procedures that may be performed over a period of time. The referral provider determines the completion of this chain of messages and indicates that designation in the following example by setting the "Processed" flag in the MSA segment. This procedure will probably vary from network to network.
HL7 v2
MSH|^~\&|BLAKEMD|EWHIN|JIME|EWHIN|19940111113142||REF^I11|BLAKEM7899|P|2.3.1|||AL|AL
RF1||R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA ^99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703|BROWN*CJ4298^WA
NK1|1|BROWN^KATHARINA^LOU|2|N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801
GT1|1||BROWN^CARY^JOE||N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801 |(509)466-0396|19600309|M||1|402941703||||WISMER*MARTIN|||456789|01
IN1|1|PPO|WA02|WSIC (WA State Code)|11223 FOURTH STREET^^MEAD^WA^99021^USA|ANN MILLER|(509)333-1234|987654321||||19901101||||BROWN^CARY^JOE|1|19600309|N. 12345 SOME STREET^^MEAD^WA^99021^USA|||||||||||||||||402941703||||||01|M
ACC|19940105125700|WR|WISMER*MARTIN
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|WA02|WSIC (WA State Code)|19940110|19940510|123456789|175|1
MSH|^~\&|JIME|EWHIN|BLAKEMD|EWHIN|19940111154812||MCF|JIME1123|P|2.3.1|||ER|ER
MSA|AA|BLAKEM7899
MSH|^~\&|JIME|EWHIN|BLAKEMD|EWHIN|19940112152401||RRI^I11|JIME1124|P|2.3.1|||ER|ER
MSA|AA|BLAKEM7899
RF1|A|R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA^ 99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703|BROWN*CJ4298^WA
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940111141509|00
NTE|||Patient is doing well.~Full recovery expected.