United States Health Information Knowledgebase

Data Elements Related to Prior Authorization Transfer

Name:	Prior Authorization Transfer
Definition:	Transferring existing prior authorization data between payer/processors when transitioning clients, performing system database or platform changes.

Results 1-50 of 68

Select All	sort Name	sort Definition
Select 200056000	Additional Message Information	Free text message.
Select 200095000	Alternate ID Number	Alternate ID number assigned to the cardholder or family member.
Select 200174000	Batch Number	A number generated by the sender to uniquely identify this batch from others, especially when multiple batches may be sent in one day.
Select 200180000	Benefit Amount	Represents the amount of the overridden amount to be applied in place of the standard plan benefit.
Select 200181000	Benefit Amount Time Period	Defines how the Benefit Amount Type override is to be applied during a time period and corresponds to the plan's benefit accrual period.
Select 200182000	Benefit Amount Type	Represents which of the benefit accumulation types is being overridden and also has an option to override all benefit amounts. This amount is usually set to an amount outside of the normal plan benefit coverage level.
Select 200183000	Benefit Amount Used To-Date	Indicates the aggregated amount of benefit used to date against a previously approved override amount.
Select 200208000	Cardholder ID	Insurance ID assigned to the cardholder or identification number used by the plan.
Select 200233000	Claim Cost Ceiling Override Amount	Represents either the specific copay Gross Amount Due or the Gross Amount Due Ceiling that the prior authorization is overriding.
Select 200237000	Claim Origination	From the plan's perspective, the method/system/application by which the payer received the claim.
Select 200244000	Client Name	Name of client.
Select 200286000	Compound Indicator	Code indicating if the prior authorization applies to compounded products only.
Select 200315000	Copay/Coinsurance Override Amount	Represents either the specific copay dollar amount or coinsurance rate that is defined in the prior authorization and is qualified by the Copay/Coinsurance Override Type (A08).
Select 200316000	Copay/Coinsurance Override Type	Indicator used to represent whether or not the override is defined as a flat dollar amount or as a percentage, and is usually outside of the normal plan benefit coverage level. Percentage may be considered a coinsurance amount.
Select 200317000	Copay Conjunction Sequence	The sequence in which a multi-tiered copay structure should be applied.
Select 200335000	Creation Date	Date the file was created.
Select 200336000	Creation Time	Time the file was created.
Select 200351000	Date Of Birth	Date of birth of patient.
Select 200359000	Days Supply	Estimated number of days the prescription will last.
Select 200362000	Days Supply Used to Date	Accumulated authorized amount of days supply used to date
Select 200386000	Dispense As Written (DAW) Difference	Indicator to determine where the cost differential of the DAW difference should be shifted.
Select 200398000	Dosage Per Day	The dosage per day that is approved by the prior authorization and is usually over or under the normal plan limits or clinical guidelines.
Select 200441000	Drug Type	Code to indicate the type of drug dispensed.
Select 200524000	File Type	Code identifying whether the file contained is test or production data.
Select 200528000	Fills/Refills Used To-Date	Indicates the number of fills or refills used to date by a patient against an existing Annual Fill or Annual Refill override.
Select 200532000	First Name	First name.
Select 200577000	Group ID	ID assigned to the cardholder group or employer group.
Select 200688000	Last Name	Last name.
Select 200778000	Middle Initial	Individual middle initial.
Select 200918000	Patient First Name	Individual first name.
Select 200919000	Patient Gender Code	Code indicating the gender of the individual.
Select 200920000	Patient ID	ID assigned to the patient.
Select 200926000	Patient ID Qualifier	Code qualifying the 'Patient ID' (332-CY).
Select 200929000	Patient Last Name	Individual last name.
Select 200938000	Patient Relationship Code	Code indicating relationship of patient to cardholder.
Select 200981000	Person Code	Code assigned to a specific person within a family.
Select 201038000	Prescriber ID	ID assigned to the prescriber.
Select 201042000	Prescriber ID Qualifier	Code qualifying the 'Prescriber ID' (411-DB).
Select 201046000	Prescriber Override Type	The override's inclusion or exclusion parameters as it applies to the prescriber network for a plan.
Select 201065000	Prescription/ Service Reference Number	Reference number assigned by the provider for the dispensed drug/product and/or service provided.
Select 201066000	Prescription/Service Reference Number Qualifier	Indicates the type of billing submitted.
Select 201068000	Previous Date of Fill	Date prescription was previously filled.
Select 201080000	Prior Authorization Create Date	The date the prior authorization record was created in sender's system.
Select 201082000	Prior Authorization Effective Date	Date the prior authorization became effective.
Select 201083000	Prior Authorization Expiration Date	Date the prior authorization ends.
Select 201084000	Prior Authorization Number-Assigned	Unique number identifying the prior authorization assigned by the processor.
Select 201085000	Prior Authorization Number of Fills Authorized	The number of fills allowed to be covered by the prior authorization and is usually over or under the normal plan limitations.
Select 201086000	Prior Authorization Number Of Refills Authorized	Number of refills authorized by the prior authorization.
Select 201087000	Prior Authorization Number Submitted	Number submitted by the provider to identify the prior authorization.
Select 201089000	Prior Authorization Quantity	Amount authorized expressed in metric decimal units.

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