APA communication

Reply to a payer's CommunicationRequest about an advanced authorization. The reply uses the payer's identifiers, not those of your own claims or prior authorizations.

Communication history

This screen answersUS-09a

Acceptance criteria

US-09a APA Polling Without Bundle Reference (TC-AUTH-010) HIGHEST

As the system, I need to poll NPHIES for payer-initiated Advanced Prior Authorizations without a reference Bundle ID, so payer-issued APAs are retrieved successfully.

Given a payer has issued an APA with no prior request from us, when Poll NPHIES runs, then the APA is retrieved and appears in the Advanced Auth module.
Given the poll runs without a bundle reference, when NPHIES returns results, then the system correctly parses and links the APA to the correct patient/provider without requiring a pre-existing internal reference.
Given the APA exists, when a communication or cancellation/change is sent against it, then the related change reflects correctly.

1. Paste the CommunicationRequest bundle

Bundle JSON

Paste the bundle exactly as NPHIES returned it.

Read bundle

2. Reply target

Communication.basedOn and Communication.about

APA (from the advanced authorization table)

Sets the APA identifier value below

CommunicationRequest identifier system

CommunicationRequest identifier value

About type

APA identifier system

From the CommunicationRequest's about.identifier.system

APA identifier value

Must match the identifier of the APA you received

Payer license (recipient)

Your provider type

Priority

Reason code

3. Patient

Filled in from the CommunicationRequest's patient

Patient ID Type

ID Number

Passport Country (optional)

3-letter ISO code (required for passport)

First Name

Middle Name (optional)

Last Name

Date of Birth

Gender

Marital Status

Occupation

4. What you are sending

Add a file, a text payload, or both.

Add file

Orthopedic-report.pdf

640 KB, PDF, JPG, PNG, DOC, DOCX, XLS or XLSX

Remove

Text payload

Note (optional)

CancelSend communication