Once pre-authorization has been received, the patient is referred to the referral provider. In the following example, Dr. Blake is referring Cary Joe Brown to Dr. Jose Jimenez for a colonoscopy. The referral message includes the patients demographic information, diagnosis and the pre-authorization information retrieved during the previous transaction. The dates contained in the pre-authorization segment (e.g., authorization date and authorization expiration date) pertain to the authorization, given by a payor, for a specified procedure. They are not intended to imply any kind of schedule request. Scheduling will be handled by the referral provider and the patient in a separate transaction. Not all referrals will require a detailed chain of response messages, so in this case, a simple acknowledgment in the form of an RPI is returned with a note from the referred-to provider.
MSH|^~\&|BLAKEMD|EWHIN|JIME|EWHIN|19940111113142||REF^I11|BLAKEM7899|P|2.3|||NE|AL<CR>
RF1||R|MED|RP|O|REF4502|19940111|19940510|19940111<CR>
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899<CR>
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER<CR>
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886<CR>
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA^99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703| BROWN*CJ4298^WA<CR>
NK1|1|BROWN^KATHARINA^LOU|2|N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801<CR>
GT1|1||BROWN^CARY^JOE||N. 12345 SOME STREET^^MEAD^WA^99021^USA|(509)466-6801|(509)466-0396|19600309|M||1|402941703|||| WISMER*MARTIN|||456789|01<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>
ACC|19940105125700|WR|WISMER*MARTIN<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>
MSH|^~\&|JIME|EWHIN|BLAKEMD|EWHIN|19940111152401||RRI^I11|JIME1123|P|2.3|||ER|ER<CR>
MSA|AA|BLAKEM7899<CR>
RF1|A|R|MED|RP|O|REF4502|19940111|19940510|19940111<CR>
PRD|RP|BLAKE^BEVERLY^^^DR^MD|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021| ^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER|BLAKEM7899<CR>
CTD|PR|JONES^BUCK|N. 12828 NEWPORT HIGHWAY^^MEAD^WA^99021|^^^BLAKEMD&EWHIN^^^^^BLAKE MEDICAL CENTER<CR>
PRD|RT|JIMENEZ^JOSE^^^DR||^^^JIME&EWHIN^^^^^JIMENEZ AND SMITH||||531886<CR>
PID|||1234567891^1^M10||BROWN^CARY^JOE||19600309|M||C|N. 12345 SOME STREET^^MEAD^WA^99021^USA|SPO|(509)466-6801|(509)466-0396|ENGL|M|M||402941703| BROWN*CJ4298^WA<CR>
DG1|1|I9|569.0|RECTAL POLYP|19940106103500|0<CR>
PR1|1|C4|45378|Colonoscopy|19940111141509|00<CR>
NTE|||Patient is doing well.~Full recovery expected.<CR>