RQA^I08
RQA/RPA - Request for treatment authorization information
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. Blake is requesting the appropriate pre-authorization from H.C Payor Insurance Company for a colonoscopy on Adam 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|^~\&|HIPPOCRATESMD|EWHIN|MSC|EWHIN|19940110105307||RQA^I08|HIPPOCRATESMD7898|P|2.8|||NE|AL
PRD|RP|HIPPOCRATES^HAROLD^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^HIPPOCRATESMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|HIPPOCRATESMD7899
PRD|RT|HIIC||^^^MSC&EWHIN^^^^^H.C.PAYOR INSURANCE COMPANY
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A||19600309||||||||||||444-33-3333
IN1|1|PPO|HC02|HCIC (MI State Code)|5555 INSURERS CIRCLE^^ANN ARBOR^MI^99999^USA|CHRISTOPHER CLERK|(855)555-1234|(555)555-3002||||19901101||||EVERYMAN^ADAM^A|1|19600309|2222 HOME STREET^^ANN ARBOR^MI^99999^USA |||||||||||||||||444333555||||||01|M
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
MSH|^~\&|MSC|EWHIN|HIPPOCRATESMD|EWHIN|19940110154812||RPA^I08|MSC2112|P|2.8|||ER|ER
MSA|AA|HIPPOCRATESMD7888
PRD|RP|HIPPOCRATES^HAROLD^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^ HIPPOCRATESMD &EWHIN^^^^^HIPPOCRATES MEDICAL CENTER| HIPPOCRATESMD7899
PRD|RT|HIIC||^^^MSC&EWHIN^^^^^H.C.PAYOR INSURANCE COMPANY
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A||19600301|||||||||||| HL71001111111111
IN1|1|PPO|HC02|HCIC (MI State Code)|5555 INSURERS CIRCLE^^ANN ARBOR^MI^99999^USA|CHRISTOPHER CLERK|(855)555-1234|(555)555-3002||||19901101||||EVERYMAN^ADAM^A|1|19600309|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|||||||||||||||||444555333||||||01|M
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|HC02|HIIC (MI State Code)|19940110|19940510|HL71001111111111|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|^~\&|HIPPOCRATESMD|EWHIN|MSC|EWHIN|19940110105307||RQA^I08|HIPPOCRATES7898|P|2.8|||AL|AL
PRD|RP| HIPPOCRATES^HAROLD ^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^HIPOOCRATES&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|HIPPOCRATESM7899
PRD|RT|HIIC||^^^MSC&EWHIN^^^^^H.C.PAYOR INSURANCE COMPANY
PID||| HL71001111111111^9^M10||EVERYMAN^ADAM^A||19600301|||||||||||| HL71001111111111
IN1|1|PPO|HC02|HCIC (MI State Code)|5555 INSURERS CIRCLE^^ANN ARBOR^MI^99999^USA|CHRISTOPHER CLERK|(855)555-1234|(555)555-3002||||19901101||||EVERYMAN^ADAM^A|1|19600309|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|||||||||||||||||444555333||||||01|M
PR1|1|C4|45378|Colonoscopy|19940110105309|00
MSH|^~\&|MSC|EWHIN|HIPPOCRATESMD|EWHIN|1994011015315||MCF|MSC2112|P|2.8|||ER|ER
MSA|AA|HIPPOCRATES7888
MSH|^~\&|MSC|EWHIN|HIPPOCRATESMD|EWHIN|19940111102304||RPA^I08|MSC2113|P|2.8|||ER|ER
MSA|AA|HIPPOCRATESM7888
PRD|RP| HIPPOCRATES^HAROLD ^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^HIPOOCRATES&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|HIPPOCRATESM7899
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^H.C.PAYOR INSURANCE COMPANY
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A ||19600301|||||||||||| HL71001111111111
IN1|1|PPO|HC02|HCIC (MI State Code)|5555 INSURERS CIRCLE^^ANN ARBOR^MI^99999^USA|CHRISTOPHER CLERK|(855)555-1234|(555)555-3002||||19901101||||EVERYMAN^ADAM^A|1|19600309|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|||||||||||||||||444555333||||||01|M
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|HC02|HIIC (MI State Code)|19940110|19940510|HL71001111111111|175|1