When the attending physician decides to refer the patient for treatment to another healthcare provider, pre-authorization may be required by the payor. In the following RQA example, Dr. Blake is requesting the appropriate pre-authorization from Washington State Insurance Company for a colonoscopy on Cary Joe Brown. The request includes the diagnosis, in case its a factor in the approval decision. As shown below, the immediate response indicates approval of the request that was made on 01/10/94 and that expires on 05/10/94. In actuality, most payors require some human intervention in the pre-authorization process and would probably not respond immediately.
MSH|^~\&|BLAKEMD|EWHIN|MSC|EWHIN|19940110105307||RQA^I08|BLAKEM7898|P|2.3|||NE|AL<CR>
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899<CR>
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^WASHINGTON STATE INSURANCE COMPANY<CR>
PID|||402941703^9^M10||BROWN^CARY^JOE||19600309||||||||||||402941703<CR>
IN1|1|PPO|WA02|WSIC (WA State Code)|11223 FOURTH STREET^^MEAD^WA^99021^USA|ANN MILLER|509)333-1234|987654321||||19901101||||BROWN^CARY^JOE|1|19600309|N. 12345 SOME STREET^^MEAD^WA^99021^USA|||||||||||||||||402941703||||||01|M<CR>
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0<CR>
PR1|1|C4|45378|Colonoscopy|19940110105309|00<CR>
MSH|^~\&|MSC|EWHIN|BLAKEMD|EWHIN|19940110154812||RPA^I08|MSC2112|P|2.3|||ER|ER<CR>
MSA|AA|BLAKEM7888<CR>
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899<CR>
PRD|RT|WSIC||^^^MSC&EWHIN^^^^^WASHINGTON STATE INSURANCE COMPANY<CR>
PID|||402941703^9^M10||BROWN^CARY^JOE||19600301||||||||||||402941703<CR>
IN1|1|PPO|WA02|WSIC (WA State Code)|11223 FOURTH STREET^^MEAD^WA^99021^USA|ANN MILLER|(509)333-1234|987654321||||19901101||||BROWN^CARY^JOE|1|19600309|N. 12345 SOME STREET^^MEAD^WA^99021^USA|||||||||||||||||402941703||||||01|M<CR>
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0<CR>
PR1|1|C4|45378|Colonoscopy|19940110105309|00<CR>
AUT|PPO|WA02|WSIC (WA State Code)|19940110|19940510|123456789|175|1<CR>