Authorizations

field name object type validation description primary key authorization string required the unique identifier for this authorization could be equivalent to authid however, it could also differ from authid if e g multiple procedures or providers should be grouped together into the same auth group block of business id group string required identifier for corresponding block of business, account, or root level division group id group string required identifier for corresponding client/group group name group string required name of group group tin group string required tin (tax id) of group group hierarchy 1 group string optional first level breakdown of group (location) group hierarchy 1 description group string optional description of first level breakdown group hierarchy 2 group string optional second level breakdown of group (division) group hierarchy 2 description group string optional description of second level breakdown member primary key member string required a key that defines the uniqueness of this member this should match the key used in other datasets member id member string required member identifier (or subscriber if subscriberprimarykey is equivalent to primarykey) often shared among a family this member will be considered the subscriber if the subscriberprimarykey is equal to this row's primarykey) member person code member string required person code corresponding to this member often 00 for member and 01, 02, 03, etc for dependents in the order they were registered member alternate id member string optional alternative identifier of member member relationship member enum relationship required member's relationship to subscriber e g , su = subscriber/self, sp = spouse, ch = child, de = other dependent, etc member ssn member string strongly recommended ssn for member some vendors will not be able to accept a family without at least a subscriber ssn member first name member string required first name of member member middle name member string required middle name of member member last name member string required last name of member member preferred first name member string optional preferred first name of member, if applicable and known member prefix member string optional prefix (e g , mr , mrs , dr ) for member member suffix member string optional suffix (e g , jr , sr , iii) for member member gender member enum gender required gender of member f, m, o, u = female, male, other, unknown member sex member enum sex required sex of member f, m, o, u = female, male, other, unknown member date of birth member fields yyyymmdd required date of birth of member member date of death member fields yyyymmdd optional date of death for member member address line 1 member string required address line 1 of member member address line 2 member string optional address line 2 of member member address line 3 member string optional address line 3 of member member city member string required city of member member state member enum state required two character state code conforming to the iso 3166 2\ us subdivision codes such as al, ak, az, ar, ca, co, etc member postal code member string required postal code of member may include 6 or 10 characters member country member enum country required two character country code conforming to iso 3166 1 alpha 2 authorization id authorization string required unique id of the authorization authorization determination authorization enum authdetermination required a=approved, d=denied, p=pending status authorization enum authstatus required a=active, i=inactive, p=pending denial reason authorization string conditionally required required if authorization determination=denied the code(s) indicating the reason(s) for denial authorization type authorization enum authtype recommended inpatient, outpatient service start date authorization fields yyyymmdd required first date of the authorized service service end date authorization fields yyyymmdd required last date of the authorized service close date authorization fields yyyymmdd optional date of closure if authorization is closed without a decision request date authorization fields yyyymmdd required date of when authorization was requested last modified date authorization fields yyyymmdd required date authorization record was last modified decision date authorization fields yyyymmdd optional date of when authorization decision was made discharge date authorization fields yyyymmdd optional date of discharge for inpatient claim case type description authorization string optional description of the type of case case level description authorization string optional description of the level of case place of service code authorization string optional cms place of service code set place of service description authorization string optional cms place of service code description procedure 1 code system authorization string required the procedure code system such as hcpcs, cpt, or icd procedure 1 code authorization string required code of the procedure procedure 1 modifier 1 authorization string optional code for modifications to procedure procedure 1 modifier 2 authorization string optional code for modifications to procedure procedure 1 modifier 3 authorization string optional code for modifications to procedure procedure 1 modifier 4 authorization string optional code for modifications to procedure procedure 1 units type authorization enum authunitstype optional visits, units, cycles, days, weeks, months, procedures procedure 1 units requested authorization decimal as string optional the number of units requested procedure 1 units approved authorization decimal as string optional the number of approved units procedure 2 code system authorization string required the procedure code system such as hcpcs, cpt, or icd procedure 2 code authorization string required code of the procedure procedure 2 modifier 1 authorization string optional code for modifications to procedure procedure 2 modifier 2 authorization string optional code for modifications to procedure procedure 2 modifier 3 authorization string optional code for modifications to procedure procedure 2 modifier 4 authorization string optional code for modifications to procedure procedure 2 units type authorization enum authunitstype optional visits, units, cycles, days, weeks, months, procedures procedure 2 units requested authorization decimal as string optional the number of units requested procedure 2 units approved authorization decimal as string optional the number of approved units procedure 3 code system authorization string required the procedure code system such as hcpcs, cpt, or icd procedure 3 code authorization string required code of the procedure procedure 3 modifier 1 authorization string optional code for modifications to procedure procedure 3 modifier 2 authorization string optional code for modifications to procedure procedure 3 modifier 3 authorization string optional code for modifications to procedure procedure 3 modifier 4 authorization string optional code for modifications to procedure procedure 3 units type authorization enum authunitstype optional visits, units, cycles, days, weeks, months, procedures procedure 3 units requested authorization decimal as string optional the number of units requested procedure 3 units approved authorization decimal as string optional the number of approved units procedure 3 units actual authorization decimal as string optional actual number of units administered procedure 4 code system authorization string required the procedure code system such as hcpcs, cpt, or icd procedure 4 code authorization string required code of the procedure procedure 4 modifier 1 authorization string optional code for modifications to procedure procedure 4 modifier 2 authorization string optional code for modifications to procedure procedure 4 modifier 3 authorization string optional code for modifications to procedure procedure 4 modifier 4 authorization string optional code for modifications to procedure procedure 4 units type authorization enum authunitstype optional visits, units, cycles, days, weeks, months, procedures procedure 4 units requested authorization decimal as string optional the number of units requested procedure 4 units approved authorization decimal as string optional the number of approved units procedure 4 units actual authorization decimal as string optional actual number of units administered care manager id authorization string optional id of the care manager assigned service comment authorization string optional coments on the authorization / case admission type authorization string optional elective, emergency room, urgent admission source authorization string optional location of patient prior to admission (example, 01=md / office clinic) admission reason authorization string optional reason for the hospital admission admission diagnosis code system authorization string optional identifies icd9 vs icd10 admission diagnosis 1 authorization string optional diagnosis code supporting the hospital admission admission diagnosis 2 authorization string optional diagnosis code supporting the hospital admission admission diagnosis 3 authorization string optional diagnosis code supporting the hospital admission admission diagnosis 4 authorization string optional diagnosis code supporting the hospital admission discharge status authorization string optional status of patient's stay at hosital discharge diagnosis code system authorization string optional identifies icd9 vs icd10 discharge diagnosis 1 authorization string optional diagnosis code supporting the hospital discharge discharge diagnosis 2 authorization string optional diagnosis code supporting the hospital discharge discharge diagnosis 3 authorization string optional diagnosis code supporting the hospital discharge discharge diagnosis 4 authorization string optional diagnosis code supporting the hospital discharge length of stay authorization decimal as string optional length of hospital stay approved days authorization decimal as string optional approved days of hospital stay diagnosis code system authorization string optional identifies icd9 vs icd10 diagnosis codes primary authorization string optional icd9 or icd10 code(s) supporting the authorization request diagnosis codes 1 authorization string optional auxiliary diagnosis codes diagnosis codes 2 authorization string optional auxiliary diagnosis codes diagnosis codes 3 authorization string optional auxiliary diagnosis codes diagnosis codes 4 authorization string optional auxiliary diagnosis codes diagnosis codes 5 authorization string optional auxiliary diagnosis codes diagnosis codes 6 authorization string optional auxiliary diagnosis codes diagnosis codes 7 authorization string optional auxiliary diagnosis codes diagnosis codes 8 authorization string optional auxiliary diagnosis codes diagnosis codes 9 authorization string optional auxiliary diagnosis codes diagnosis codes 10 authorization string optional auxiliary diagnosis codes diagnosis codes 11 authorization string optional auxiliary diagnosis codes diagnosis codes 12 authorization string optional auxiliary diagnosis codes diagnosis codes 13 authorization string optional auxiliary diagnosis codes diagnosis codes 14 authorization string optional auxiliary diagnosis codes diagnosis codes 15 authorization string optional auxiliary diagnosis codes diagnosis codes 16 authorization string optional auxiliary diagnosis codes diagnosis codes 17 authorization string optional auxiliary diagnosis codes diagnosis codes 18 authorization string optional auxiliary diagnosis codes rendering facility name provider string required name of the rendering facility for this authorization rendering facility tax id provider string optional tax id of the rendering facility rendering facility id provider string optional system id of rendering facility rendering facility npi provider string required npi of the rendering facility rendering facility address provider string required address of the rendering facility for this authorization rendering facility state provider enum state required state of the rendering facility for this authorization rendering facility city provider string required city of the rendering facility for this authorization rendering facility country provider enum country required country of the rendering facility rendering facility postal code provider string required postal code of the rendering facility for this authorization rendering physician id provider string optional system id of rendering physician rendering physician first name provider string required first name of rendering physician for this authorization rendering physician last name provider string required last name of the patient rendering physician npi provider string required npi of the rendering physician for this authorization rendering physician tin provider string optional tax id of the rendering physician rendering physician address line 1 provider string required address line1 for the rendering physician rendering physician address line 2 provider string optional address line2 for the rendering physician rendering physician city provider string required city for the rendering physician rendering physician state provider enum state required state for the rendering physician rendering physician postal code provider string required postal code for the rendering physician rendering physician country provider enum country required country for the rendering physician referring facility name provider string required name of the referring facility for this authorization referring facility tax id provider string optional tax id of the referring facility referring facility id provider string optional system id of referring facility referring facility npi provider string required npi of the referring facility referring facility address provider string required address of the referring facility for this authorization referring facility state provider enum state required state of the referring facility for this authorization referring facility city provider string required city of the referring facility for this authorization referring facility country provider enum country required country of the referring facility referring facility postal code provider string required postal code of the referring facility for this authorization referring physician id provider string optional system id of referring physician referring physician first name provider string required first name of referring physician for this authorization referring physician last name provider string required last name of the patient referring physician npi provider string required npi of the referring physician for this authorization referring physician tin provider string optional tax id of the referring physician referring physician address line 1 provider string required address line1 for the referring physician referring physician address line 2 provider string optional address line2 for the referring physician referring physician city provider string required city for the referring physician referring physician state provider enum state required state for the referring physician referring physician postal code provider string required postal code for the referring physician referring physician country provider enum country required country for the referring physician custom 1 authorization string optional custom field custom 2 authorization string optional custom field custom 3 authorization string optional custom field custom 4 authorization string optional custom field custom 5 authorization string optional custom field custom 6 authorization string optional custom field custom 7 authorization string optional custom field custom 8 authorization string optional custom field custom 9 authorization string optional custom field custom 10 authorization string optional custom field