RQA^I11
RQA/RPA - Request for cancellation of an authorization
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
TriggerI11
SendRQA_I08
ReceiveRPA_I08
Worked Examples
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. Hippocrates is referring Adam Everyman to Dr. Tony Tum 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|^~\&|HIPPOCRATESMD|EWHIN|TUM|EWHIN|19940111113142||REF^I11|HIPPOCRATESM7899|P|2.8|||NE|AL
RF1||R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|HIPPOCRATES^HAROLD^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^HIPPOCRATESMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|HIPPOCRATES7899
CTD|PR|ENTER^ELLEN|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999^USA^|^^^HIPPOCRATESMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER
PRD|RT|TUM^TONY^^^DR||^^^JIME&EWHIN^^^^^TUM AND TUMOR||||531886
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A ||19600309|M||C|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|SPO|(555)555-2004|ENGL|M|M||HL71001111111111EVERYMAN*3-444-555^MI
NK1|1|EVERYMAN^BETTERHALF^W|2|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|(555)555-2004
GT1|1||EVERYMAN^ADAM^A||2222 HOME STREET^^ANN ARBOR^MI^99999^USA|(555)4555-2004|(555)555-2004|19600309|M||1|402941703||||CONTACT*CARRIE|||456789|01
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
ACC|19940105125700|WR|ENTER*ELLEN<
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|WA02|HCIC (MI State Code)|19940110|19940510|123456789|175|1
MSH|^~\&|TUM|EWHIN|HIPPOCRATESMD|EWHIN|19940111152401||RRI^I11|TUM1123|P|2.8|||ER|ER
MSA|AA|TUMM7900
RF1|A|R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|TUM^TONY^^^DR^MD|1031 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^TUMMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|TUMMT7900
CTD|PR|ENTER^ELLEN|1021 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999|^^^TUMTMD&EWHIN^^^^^TUM MEDICAL CENTER
PRD|RT|TUM^TONY^^^DR||^^^TUM&EWHIN^^^^^TUM AND TUMOR||||531886
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A ||19600309|M||C|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|SPO|(555)555-2004|ENGL|M|M||HL71001111111111EVERYMAN*3-444-555^MI
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940111141509|00
NTE|||Patient is doing well.~Full recovery expected.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|^~\&|TUMMD|EWHIN|HIPPOCRATESMD|EWHIN|19940111113142||REF^I11|TUMMM7899|P|2.8|||AL|AL
RF1||R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|TUM^TONY^^^DR^MD|1031 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^TUMMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|TUMMT7900
CTD|PR|ENTER^ELLEN|1021 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999|^^^TUMTMD&EWHIN^^^^^TUM MEDICAL CENTER
PRD|RT|TUM^TONY^^^DR||^^^TUM&EWHIN^^^^^TUM AND TUMOR||||531886
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A ||19600309|M||C|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|SPO|(555)555-2004|ENGL|M|M||HL71001111111111EVERYMAN*3-444-555^MI
NK1|1|EVERYMAN^BETTERHALF^W|2|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|(555)555-2004
GT1|1||EVERYMAN^ADAM^A||2222 HOME STREET^^ANN ARBOR^MI^99999^USA|(555)4555-2004|(555)555-2004|19600309|M||1|402941703||||CONTACT*CARRIE|||456789|01
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
ACC|19940105125700|WR|ENTER*ELLEN
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940110105309|00
AUT|PPO|HC02|HCIC (MI State Code)|19940110|19940510|123456789|175|1
MSH|^~\&|TUMMD|EWHIN|HIPPOCRATESMD|EWHIN|19940111154812||MCF|TUMT1123|P|2.8|||ER|ER
MSA|AA|TUMM7899
MSH|^~\&|TUM|EWHIN|HIPPOCRATESMD|EWHIN|19940112152401||RRI^I11|TUMTE1124|P|2.8|||ER|ER
MSA|AA|HIPPOCRATESM7899
RF1|A|R|MED|RP|O|REF4502|19940111|19940510|19940111
PRD|RP|HIPPOCRATES^HAROLD^^^DR^MD|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999|^^^HIPPOCRATESMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|HIPPOCRATESM7899
CTD|PR|ENTER^ELLEN|1001 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999|^^^HIPPOCRATESMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER
PRD|RP|TUM^TONY^^^DR^MD|1031 HEALTHCARE DRIVE^^ANN ARBOR^MI^99999| ^^^TUMMD&EWHIN^^^^^HIPPOCRATES MEDICAL CENTER|TUMMT7900
PID|||HL71001111111111^9^M10||EVERYMAN^ADAM^A ||19600309|M||C|2222 HOME STREET^^ANN ARBOR^MI^99999^USA|SPO|(555)555-2004|ENGL|M|M||HL71001111111111EVERYMAN*3-444-555^MI
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0
PR1|1|C4|45378|Colonoscopy|19940111141509|00
NTE|||Patient is doing well.~Full recovery expected.