EnrollEligCOB
Class PriorAuthorizationRequest

"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.

Attributes
«II» Id authorizationId authorizationId

"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.
"Number assigned by the processor to identify an authorized transaction." - NCPDP Telecommunication (Field 503-F3, Data Dictionary 201104).
"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.

Participation authorizedRepresentative authorizedRepresentative

Authorized Representative first name, last name, street address, city, state, and zipcode. - NCPDP Telecommunication (Fields 498-PE, 498-PF, 498-PG, 498-PH, 498-PJ, and 498-PK).

«IVL_TS» Period effectiveDateRange effectiveDateRange

"Beginning date for a prior authorization request." - NCPDP Telecommunication (Field 498-PB, Data Dictionary 201104).
"Ending date for a prior authorization request." - NCPDP Telecommunication (Field 498-PC, Data Dictionary 201104).

«II» Id previousAuthorizationId previousAuthorizationId

"Unique number identifying the prior authorization assigned by the processor. Provided to the pharmacy by the processor to be used by the pharmacy for billing, and if applicable, reversal purposes." - NCPDP Telecommunication (Field 498-PY, Data Dictionary 201104).

«CS» Code requestBasis requestBasis

"Code describing the reason for prior authorization request." - NCPDP Telecommunication (Field 498-PD, Data Dictionary 201104). Possible values include: Medical Exception; Plan Requirement; Increase Plan Limitation.

«CS» Code requestType requestType

"Code identifying type of prior authorization request. Used by processor to distinguish reason for prior authorization request." - NCPDP Telecommunication (Field 498-PA, Data Dictionary 201104). Possible values include: Initial; Reauthorization; Deferred.

String supportingDocumentation supportingDocumentation

"Could be used, if applicable, to supply information not already included in NCPDP data fields that may be required to process a prior authorization transaction." - NCPDP Telecommunication (Field 498-PP, Data Dictionary 201104).


Properties:

Alias
Classifier Behavior
Is Abstractfalse
Is Activefalse
Is Leaffalse
Keywords
NamePriorAuthorizationRequest
Name Expression
NamespaceEnrollEligCOB
Owned Template Signature
OwnerEnrollEligCOB
Owning Template Parameter
PackageEnrollEligCOB
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest
Representation
Stereotype
Template Parameter
VisibilityPublic

Attribute Details

 authorizationId
Public «II» Id authorizationId

"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.
"Number assigned by the processor to identify an authorized transaction." - NCPDP Telecommunication (Field 503-F3, Data Dictionary 201104).
"Based on the type of insurance, some coverage plans require that an authorization number or code be obtained prior to all non-emergency admissions, and within 48 hours of an emergency admission. Insurance billing would not be permitted without this number. The date and source of authorization are the components of this field." - HL7 Version 2.8, IN1-14.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NameauthorizationId
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::authorizationId
Stereotype
Template Parameter
Type«II» Id
Upper1
Upper Value(1)
VisibilityPublic


 authorizedRepresentative
Public Participation authorizedRepresentative

Authorized Representative first name, last name, street address, city, state, and zipcode. - NCPDP Telecommunication (Fields 498-PE, 498-PF, 498-PG, 498-PH, 498-PJ, and 498-PK).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameauthorizedRepresentative
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::authorizedRepresentative
Stereotype
Template Parameter
TypeParticipation
Upper1
Upper Value(1)
VisibilityPublic


 effectiveDateRange
Public «IVL_TS» Period effectiveDateRange

"Beginning date for a prior authorization request." - NCPDP Telecommunication (Field 498-PB, Data Dictionary 201104).
"Ending date for a prior authorization request." - NCPDP Telecommunication (Field 498-PC, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NameeffectiveDateRange
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::effectiveDateRange
Stereotype
Template Parameter
Type«IVL_TS» Period
Upper1
Upper Value(1)
VisibilityPublic


 previousAuthorizationId
Public «II» Id previousAuthorizationId

"Unique number identifying the prior authorization assigned by the processor. Provided to the pharmacy by the processor to be used by the pharmacy for billing, and if applicable, reversal purposes." - NCPDP Telecommunication (Field 498-PY, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamepreviousAuthorizationId
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::previousAuthorizationId
Stereotype
Template Parameter
Type«II» Id
Upper1
Upper Value(1)
VisibilityPublic


 requestBasis
Public «CS» Code requestBasis

"Code describing the reason for prior authorization request." - NCPDP Telecommunication (Field 498-PD, Data Dictionary 201104). Possible values include: Medical Exception; Plan Requirement; Increase Plan Limitation.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamerequestBasis
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::requestBasis
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 requestType
Public «CS» Code requestType

"Code identifying type of prior authorization request. Used by processor to distinguish reason for prior authorization request." - NCPDP Telecommunication (Field 498-PA, Data Dictionary 201104). Possible values include: Initial; Reauthorization; Deferred.

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower1
Lower Value(1)
Multiplicity1
NamerequestType
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::requestType
Stereotype
Template Parameter
Type«CS» Code
Upper1
Upper Value(1)
VisibilityPublic


 supportingDocumentation
Public String supportingDocumentation

"Could be used, if applicable, to supply information not already included in NCPDP data fields that may be required to process a prior authorization transaction." - NCPDP Telecommunication (Field 498-PP, Data Dictionary 201104).

Constraints:
Properties:

AggregationNone
Alias
Association
Association End
ClassPriorAuthorizationRequest
Datatype
Default
Default Value
Is Compositefalse
Is Derivedfalse
Is Derived Unionfalse
Is Leaffalse
Is Orderedfalse
Is Read Onlyfalse
Is Staticfalse
Is Uniquetrue
Keywords
Lower0
Lower Value(0)
Multiplicity0..1
NamesupportingDocumentation
Name Expression
NamespacePriorAuthorizationRequest
Opposite
OwnerPriorAuthorizationRequest
Owning Association
Owning Template Parameter
Qualified NameFHIM::EnrollEligCOB::PriorAuthorizationRequest::supportingDocumentation
Stereotype
Template Parameter
TypeString
Upper1
Upper Value(1)
VisibilityPublic