RQA^I08
RQA/RPA - Request for treatment authorization information
Patient Referral
All trigger events in this group use the following message definition.
Note: The abstract message definitions for both the RPA and RQA include the patient visit segments (PV1 and PV2). The PV1 and PV2 segments appear in the RPA and RQA as an optional grouping to specify the visit or encounter that generated the referral authorization request. The PV1 and PV2 should not be used to provide suggested information for a future encounter or visit generated by the referral authorization request.
Message Types
Message Type
Trigger Structure
Return Structure
Event Flow
TriggerI08
SendRQA_I08
ReceiveRPA_I08
Worked Examples
RQA Message Using an I08 Event with an Immediate Response
When the attending physician decides to refer the patient for treatment to another healthcare provider, pre-authorization may be required by the payor. In the following RQA example, Dr. EVERYMAN is requesting the appropriate pre-authorization from EVERY INSURANCE COMPANY for a colonoscopy on ADAM A EVERYMAN. The request includes the diagnosis, in case it is a factor in the approval decision. As shown below, the immediate response indicates approval of the request that was made on 01/10/94 and that expires on 05/10/94. In actuality, most payors require some human intervention in the pre-authorization process and would probably not respond immediately.
HL7 v2
MSH|^~\&|EVERYMANMD|EWHIN|MSC|EWHIN|19940110105307||RQA^I08|EVERYMANM7898|P|2.5.1|||NE|AL
PRD|RP|EVERYMAN^ADAM^^^DR^MD|4444 HOME STREET^^MEAD^WA^99999| ^^^EVERYMANMD&EWHIN^^^^^GOOD HEALTH HOSPITAL|EVERYMANM7899
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^EVERY INSURANCE COMPANY
PID|||1^9^M10||EVERYMAN^ADAM^A||19600309||||||||||||
IN1|1|PPO|WA02|WSIC (WA State Code)|4444 HOME STREET^^MEAD^WA^99999^USA|EVE EVERYWOMAN||||||19901101||||EVERYMAN^ADAM^A|1|19600309|4444 HOME STREET^^MEAD^WA^99999^USA|||||||||||||||||||||||01|M
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
MSH|^~\&|MSC|EWHIN|EVERYMANMD|EWHIN|19940110154812||RPA^I08|MSC2112|P|2.5.1|||ER|ER
MSA|AA|EVERYMANM7888
PRD|RP|EVERYMAN^ADAM^^^DR^MD|4444 HOME STREET^^MEAD^WA^99999| ^^^EVERYMANMD&EWHIN^^^^^GOOD HEALTH HOSPITAL|EVERYMANM7899
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^EVERY INSURANCE COMPANY
PID|||402941703^9^M10||EVERYMAN^ADAM^A||19600301||||||||||||1
IN1|1|PPO|WA02|WSIC (WA State Code)|4444 HOME STREET^^MEAD^WA^99999^USA|EVE EVERYWOMAN||1||||19901101||||EVERYMAN^ADAM^A|1|19600309|4444 HOME STREET^^MEAD^WA^99999^USA|||||||||||||||||1||||||01|M
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|1RQA Message Using an I08 Event with a Deferred Response
In the following example of a pre-authorization request, the payor indicates his receipt of the request (a standard acknowledgment message), but defers issuing a pre-authorization to a later time. This response represents a more typical payor transaction sequence. Note the use of the “Accept Acknowledgment Type,” requiring the receiving system to respond in all cases to receipt of the message.
HL7 v2
MSH|^~\&|EVERYMANMD|EWHIN|MSC|EWHIN|19940110105307||RQA^I08|EVERYMANM7898|P|2.5.1|||AL|AL
PRD|RP|EVERYMAN^ADAM^^^DR^MD|4444 HOME STREET^^MEAD^WA^99999| ^^^EVERYMANMD&EWHIN^^^^^GOOD HEALTH HOSPITAL|EVERYMANM7899
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^EVERY INSURANCE COMPANY
PID|||1^9^M10||EVERYMAN^ADAM^A||19600301||||||||||||1
IN1|1|PPO|WA02|WSIC (WA State Code)|4444 HOME STREET^^MEAD^WA^99999^USA|EVE EVERYWOMAN||||||19901101||||EVERYMAN^ADAM^A|1|19600309|4444 HOME STREET^^MEAD^WA^99999^USA|||||||||||||||||402941703||||||01|M
PR1|1|C4|45378|Colonoscopy|19940110105309|00
MSH|^~\&|MSC|EWHIN|EVERYMANMD|EWHIN|1994011015315||MCF|MSC2112|P|2.5.1|||ER|ER
MSA|AA|EVERYMANM7888
MSH|^~\&|MSC|EWHIN|EVERYMANMD|EWHIN|19940111102304||RPA^I08|MSC2113|P|2.4|||ER|ER
MSA|AA|EVERYMANM7888
PRD|RP|EVERYMAN^ADAM^^^DR^MD|4444 HOME STREET^^MEAD^WA^99999| ^^^EVERYMANMD&EWHIN^^^^^GOOD HEALTH HOSPITAL|EVERYMANM7899
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^EVERY INSURANCE COMPANY
PID|||1^9^M10||EVERYMAN^ADAM^A||19600301||||||||||||1
IN1|1|PPO|WA02|WSIC (WA State Code)|4444 HOME STREET^^MEAD^WA^99999^USA|EVE EVERYWOMAN||987654321||||19901101||||EVERYMAN^ADAM^A|1|19600309|4444 HOME STREET^^MEAD^WA^99999^USA|||||||||||||||||1||||||01|M
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|WA02|WSIC (WA State Code)|19940110|19940510|123456789|175|1