18.4.137 QBP^E22 - Query Authorization Request Status (event E22) (16.3.12)

This message is used to query the status of an Authorization Request. There are 2 types of queries handled by this message: 1) a specific Authorization Request or 2) a specific Product/Service Line Item. If a Provider wants to obtain information on a group of Authorization Requests (e.g., submitted in a date range), each individual Authorization Request must be queried.

Note: The response to this query has the same content as an EHC^E24 - Authorization Response message.

Processing Rules:

• The Provider Application and the Payer Application must uniquely identify each Authorization Request, Product/Service Group, Product/Service Line Item and Adjustment. These numbers appear as a pair on the IVC, PSG, PSL and ADJ segments and must be echoed on any subsequent interactions for the Authorization Request, group or line item between the Provider Application and Payer Application.

• The Provider Application and/or Payer Application may also supply a tracking number for each Product/Service Line Item it processes, specified as the Provider Tracking Number or Payer Tracking Number.The Provider Tracking Number and Payer Tracking Number must be echoed on any subsequent interactions for the Product/Service Line Item between the Provider Application and Payer Application.

• A unique query identifier (Query Tag on QPD) must be generated for each query.

• Selection criteria for one of the 2 supported methods must be entered as below:

Query for a specific Authorization Request:

• Sending Application on MSH.

• Sending Organization from original Authorization Request (Sending Organization on QPD).

• Provider Organization from original Authorization Request (Provider Organization on QPD).

• Payer Organization from original Authorization Request (Payer Organization on QPD).

• Provider Invoice Number on QPD.

• Payer Invoice Number on QPD.

Query for a specific Product/Service Line Item - same as Query for a specific Authorization Request PLUS:

• Product/Service Line Item (Product/Service Line Item Number on QPD).

• Sending Organization and Sending Application on input message must be the same as the Sending Organization and Sending Application from the original Authorization Request (submitted via the EHC^E20 - Submit Authorization Request message).

• Provider Invoice Number + Payer Invoice Number + Product/Service Line Item Number on input message must exist on Payer Application's database and must point to the same Product/Service Line Item, otherwise an error must be generated (mismatched Authorization Request and/or Product/Service Line Item).