AUT
Authorization Information
This segment represents an authorization or a pre-authorization for a referred procedure or requested service by the payor covering the patient's health care.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
29
| C.Len | Element | v2.8.2 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | - | - | CWE | O | 1 | 0072 | 01146 | AUT-1 | Authorizing Payor, Plan ID | |
| 2 | - | - | CWE | R | 1 | 0285 | 01147 | AUT-2 | Authorizing Payor, Company ID | |
| 3 | - | 45# | ST | O | 1 | - | 01148 | AUT-3 | Authorizing Payor, Company Name | |
| 4 | - | - | DTM | O | 1 | - | 01149 | AUT-4 | Authorization Effective Date | |
| 5 | - | - | DTM | O | 1 | - | 01150 | AUT-5 | Authorization Expiration Date | |
| 6 | - | - | EI | C | 1 | - | 01151 | AUT-6 | Authorization Identifier | |
| 7 | - | - | CP | O | 1 | - | 01152 | AUT-7 | Reimbursement Limit | |
| 8 | - | - | CQ | O | 1 | - | 01153 | AUT-8 | Requested Number of Treatments | |
| 9 | - | - | CQ | O | 1 | - | 01154 | AUT-9 | Authorized Number of Treatments | |
| 10 | - | - | DTM | O | 1 | - | 01145 | AUT-10 | Process Date | |
| 11 | - | - | CWE | O | * | 0522 | 02375 | AUT-11 | Requested Discipline(s) | Table |
| 12 | - | - | CWE | O | * | 0546 | 02376 | AUT-12 | Authorized Discipline(s) | Table |
| 13 | ..250 | - | CWE | R | 1 | 0551 | 03413 | AUT-13 | Authorization Referral Type | 2 |
| 14 | ..250 | - | CWE | O | 1 | 0563 | 03414 | AUT-14 | Approval Status | 2 |
| 15 | ..24 | - | DTM | O | 1 | - | 03415 | AUT-15 | Planned Treatment Stop Date | |
| 16 | ..250 | - | CWE | O | 1 | 0573 | 03416 | AUT-16 | Clinical Service | 2 |
| 17 | ..60 | - | ST | O | 1 | - | 03417 | AUT-17 | Reason Text | Length |
| 18 | ..721 | - | CQ | O | 1 | - | 03418 | AUT-18 | Number of Authorized Treatments/Units | |
| 19 | ..721 | - | CQ | O | 1 | - | 03419 | AUT-19 | Number of Used Treatments/Units | |
| 20 | ..721 | - | CQ | O | 1 | - | 03420 | AUT-20 | Number of Schedule Treatments/Units | |
| 21 | ..250 | - | CWE | O | 1 | 0574 | 03421 | AUT-21 | Encounter Type | 2 |
| 22 | ..20 | - | MO | O | 1 | - | 03422 | AUT-22 | Remaining Benefit Amount | |
| 23 | ..250 | - | XON | O | 1 | - | 03423 | AUT-23 | Authorized Provider | Length |
| 24 | ..250 | - | XCN | O | 1 | - | 03424 | AUT-24 | Authorized Health Professional | Length |
| 25 | ..60 | - | ST | O | 1 | - | 03425 | AUT-25 | Source Text | Length |
| 26 | ..24 | - | DTM | O | 1 | - | 03426 | AUT-26 | Source Date | |
| 27 | ..250 | - | XTN | O | 1 | - | 03427 | AUT-27 | Source Phone | Length |
| 28 | ..254 | - | ST | O | 1 | - | 03428 | AUT-28 | Comment | |
| 29 | ..1 | - | ID | O | 1 | 0206 | 03429 | AUT-29 | Action Code |
11