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11.5.2 AUT - authorization information segment

This segment represents an authorization or a pre-authorization for a referred procedure or requested service by the payor covering the patient’s health care.

Figure 11-3. AUT attributes

SEQ

LEN

DT

OPT

RP/#

TBL#

ITEM#

ELEMENT NAME

1

200

CE

O


0072

01146

Authorizing Payor, Plan ID

2

200

CE

R


0285

01147

Authorizing Payor, Company ID

3

45

ST

O



01148

Authorizing Payor, Company Name

4

26

TS

O



01149

Authorization Effective Date

5

26

TS

O



01150

Authorization Expiration Date

6

30

EI

C



01151

Authorization Identifier

7

25

CP

O



01152

Reimbursement Limit

8

2

NM

O



01153

Requested Number of Treatments

9

2

NM

O



01154

Authorized Number of Treatments

10

26

TS

O



01145

Process Date

11.5.2.0 AUT - field definitions

11.5.2.1 Authorizing payor, plan ID (CE) 01146

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the ID of the coverage plan authorizing treatment. Values should be entries in a locally-defined table of plan codes. Refer to user-defined table 0072 - Insurance company plans for suggested values.

11.5.2.2 Authorizing payor, company ID (CE) 01147

Components: <identifier (ST)> ^ <text (ST)> ^ <name of coding system (ST)> ^ <alternate identifier (ST)> ^ <alternate text (ST)> ^ <name of alternate coding system (ST)>

Definition: This field contains the ID of the insurance company or other entity that administers the authorizing coverage plan. Values may be entries in a locally defined table of payor codes. Refer to user-defined table 0285 - Insurance company ID codes for suggested values.

11.5.2.3 Authorizing payor, company name (ST) 01148

Definition: This field contains the name of the insurance company or other entity that administers the authorizing coverage plan.

11.5.2.4 Authorization effective date (TS) 01149

Definition: This field contains the effective date of the authorization.

11.5.2.5 Authorization expiration date (TS) 01150

Definition: This field contains the expiration date after which the authorization to treat will no longer be in effect from the perspective of the coverage plan.

11.5.2.6 Authorization identifier (EI) 01151

Components: <entity identifier (ST)> ^ <namespace ID (IS)> ^ <universal ID (ST)> ^ <universal ID type (ID)>

Definition: This field contains the coverage application’s permanent identifier assigned to track the authorization and all related billing documents. This field is conditionally required. It is not required when authorization information is being requested. However, it is required when this segment is contained in a message which is responding to a request and contains the authorization information. This is a composite field.

The first component of this field is a string of up to 15 characters that identifies an individual authorization. It is assigned by the coverage application, and it identifies an authorization, and the subsequent billing transactions resulting from the given authorization, uniquely among all such authorizations granted from a particular processing application.

The second component contains the application identifier for the coverage application. The application identifier is a string of up to six characters that is uniquely associated with an application. A given healthcare provider facility, or group of intercommunicating healthcare provider facilities, should establish a unique list of applications that may be potential originators and recipients, and then assign unique application identifiers to each of those applications. This list of application identifiers becomes one of the healthcare provider facility’s master dictionary lists. Since applications fulfilling different application roles can send and receive referral messages containing authorizations, the coverage application identifier may not identify the application sending or receiving a particular message. Data elements on the Message Header (MSH) segment are available to identify the actual sending and receiving applications.

11.5.2.7 Reimbursement limit (CP) 01152

Components: <price (CP)> ^ <price type (ID)> ^ <from value (NM)> ^ <to value (NM)> ^ <range units (CE)> ^ <range type (ID)>

Definition: This field contains the dollar limit for reimbursement specified by the coverage plan for the authorized treatment.

11.5.2.8 Requested number of treatments (NM) 01153

Definition: This field contains the requested number of times that the treatment may be administered to the patient without obtaining additional authorization.

11.5.2.9 Authorized number of treatments (NM) 01154

Definition: This field contains the number of times that the authorized treatment may be administered to the patient without obtaining additional authorization.

11.5.2.10 Process date (TS) 01145

Definition: This field contains the date that the authorization originated with the authorizing party.

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