Transaction Prior Request/Authorization (Click to view large image)


  1. Payer must respond if request cancellation is not possible
  2. Payment Amount must have value and DenialCode must be empty if payer replies with trade drug for prescription request
  3. Authorization for EncounterType = 7 is not allowed (Network/encounter type access verification must be used instead)
  4. DenialCode is mandatory if Authorization.Result = No
  5. Must be empty for Activity.Type=10 [Generic drug], otherwise can have value
  6. IDPayer is mandatory if resubmission object is presented, otherwise must be empty
  7. Mandatory if request is approved or at least one activity is approved; optional otherwise
  8. See Business Rules 6.1 and 6.2 for observation requirements
  9. Effective 1 Jun 2013
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