RPA_I10

11.3.4 RQA/RPA - request for resubmission of an authorization (event I10)

27 segments

If a previously submitted request for treatment authorization is rejected or canceled, this event could trigger a resubmission message for a referenced authorization. For example, the payor may have rejected a request until additional clinical information is sent to support the authorization request.

Message Structure

27 segments
R RequiredO Optional Choice
MSH
R1
MSA
R1
RF1
O1
AUTHORIZATION
O1
AUT
R1
CTD
O1
PROVIDER
R*
PRD
R1
CTD
O*
PID
R1
NK1
O*
GT1
O*
INSURANCE
O*
IN1
R1
IN2
O1
IN3
O1
ACC
O1
DG1
O*
DRG
O*
AL1
O*
PROCEDURE
R*
PR1
R1
AUTHORIZATION
O1
AUT
R1
CTD
O1
RESULTS
O*
OBR
R1
NTE
O*
OBSERVATION
O*
OBX
R1
NTE
O*
VISIT
O1
PV1
R1
PV2
O1
NTE
O*