United States Health Information Knowledgebase

 

Prior Authorization


Name:Prior Authorization
Type:Model View
Definition:Prior Authorization Transactions September 1999. With the advent of federal and state Health Care Reform initiatives, NCPDP has developed Prior Authorization Transactions. To date, the prior authorization process has largely been a manual process for the pharmacist, the medical consultant, the processor and the client. The benefits of the standardized transactions include: the use in an interactive environment with either an immediate response or delayed response; includes the current claim format with the addition of the prior authorization fields in the optional portion for ease of implementation as well as allowing for the adjudication of the claim; eliminates the majority of paper prior authorizations and provides a standardized format for submittal of prior authorizations The NCPDP Prior Authorization Transactions are intended to meet two needs within the pharmaceutical drug claim industry; to provide a practical guideline for software developers throughout the industry as they begin to implement the standard, and to ensure a consistent implementation throughout the industry.
Registration Authority:National Council for Prescription Drug Programs
Status:Recorded
Administrative Attributes
Responsible Organization:National Council for Prescription Drug Programs
Submitting Organization:National Council for Prescription Drug Programs
Steward Organization:National Council for Prescription Drug Programs
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Relationship Organization Item
utilizes NCPDP Authorization Number   
utilizes NCPDP Authorized Representative City Address   
utilizes NCPDP Authorized Representative First Name   
utilizes NCPDP Authorized Representative Last Name   
utilizes NCPDP Authorized Representative State/Province Address   
utilizes NCPDP Authorized Representative Street Address   
utilizes NCPDP Authorized Representative Zip/Postal Zone   
utilizes NCPDP Basis Of Request   
utilizes NCPDP Prescriber Last Name   
utilizes NCPDP Prescriber Phone Number   
utilizes NCPDP Prior Authorization Effective Date   
utilizes NCPDP Prior Authorization Expiration Date   
utilizes NCPDP Prior Authorization Number-Assigned   
utilizes NCPDP Prior Authorization Processed Date   
utilizes NCPDP Request Period Date-Begin   
utilizes NCPDP Request Period Date-End   
utilizes NCPDP Request Type   
utilizes NCPDP Version/Release Number   
Relationship Organization Item
is a sub view of NCPDP Data Dictionary Compare these items   
is a sub view of NCPDP NCPDP High Level Outline Graphic Compare these items   
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