EHI Export
The TruBridge EHR platform Electronic Prior Authorization file output format.
The ePA files are named following the naming convention as follows:
Rx_spid_profile_visit_xmlFileName_CreationDate_CreationTime
An example of this naming convention:
Rx_1_12345678_123456_SSEPA00004940_1_2_sent_20230101_1200000000
The file output consists of XML data in the NCPDP format(NCPDP SCRIPT Version 2013101).
Example data file format:
<transport:Message StructuresVersion="v2013101"
ECLVersion="v2013101"
DatatypesVersion="v2013101"
TransactionDomain="SCRIPT"
PA-StructuresVersion="v2013101"
TransactionVersion="v2013101"
TransportVersion="v2013101"
xsi:schemaLocation="http://www.ncpdp.org/schema/transport transport.xsd"
xmlns:transport="http://www.ncpdp.org/schema/transport"
xmlns:datatypes="http://www.ncpdp.org/schema/datatypes"
xmlns:script="http://www.ncpdp.org/schema/script"
xmlns:structures="http://www.ncpdp.org/schema/structures"
xmlns:pastructures="http://www.ncpdp.org/schema/pa-structures"
xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<transport:Header>
<transport:To Qualifier="ZZZ">EPAINI</transport:To>
<transport:From Qualifier="D">77777777</transport:From>
<transport:MessageID>1234567</transport:MessageID>
<transport:SentTime>2015-09-04T17:18:14.1Z</transport:SentTime>
<transport:Security>
<transport:Sender>
<transport:TertiaryIdentification>ACCT_ID_INSERTED_BY_SS</transport:TertiaryIdentification>
</transport:Sender>
<transport:Receiver>
<transport:TertiaryIdentification>ACCT_ID_INSERTED_BY_SS</transport:TertiaryIdentification>
</transport:Receiver>
</transport:Security>
<transport:SenderSoftware>
<transport:SenderSoftwareDeveloper>MDLITE</transport:SenderSoftwareDeveloper>
<transport:SenderSoftwareProduct>443</transport:SenderSoftwareProduct>
<transport:SenderSoftwareVersionRelease>2.1</transport:SenderSoftwareVersionRelease>
</transport:SenderSoftware>
</transport:Header>
<transport:Body>
<transport:PAInitiationRequest>
<script:PAReferenceID>77XX2</script:PAReferenceID>
<script:BenefitsCoordination>
<structures:PayerIdentification>
<datatypes:PayerID>P00000000001192</datatypes:PayerID>
<datatypes:ProcessorIdentificationNumber>PCN9110</datatypes:ProcessorIdentificationNumber>
<datatypes:BINLocationNumber>994336</datatypes:BINLocationNumber>
<datatypes:MutuallyDefined>771041747</datatypes:MutuallyDefined>
</structures:PayerIdentification>
<structures:PayerName>PBMA</structures:PayerName>
<structures:CardholderID>209837423</structures:CardholderID>
<structures:CardHolderName>
<datatypes:LastName>JOHNSON</datatypes:LastName>
<datatypes:FirstName>RONALD</datatypes:FirstName>
<datatypes:MiddleName>C</datatypes:MiddleName>
</structures:CardHolderName>
<structures:GroupID>0998723</structures:GroupID>
<structures:GroupName>9110/3TIER/25</structures:GroupName>
<structures:PBMMemberID>0398473070389475</structures:PBMMemberID>
</script:BenefitsCoordination>
<script:Patient>
<structures:Identification>
<datatypes:MedicareNumber>333445556A</datatypes:MedicareNumber>
<datatypes:SocialSecurity>333445556</datatypes:SocialSecurity>
</structures:Identification>
<structures:Name>
<datatypes:LastName>SMITH</datatypes:LastName>
<datatypes:FirstName>MAUREEN</datatypes:FirstName>
</structures:Name>
<structures:Gender>F</structures:Gender>
<structures:DateOfBirth>
<datatypes:Date>1934-11-27</datatypes:Date>
</structures:DateOfBirth>
<structures:Address>
<datatypes:AddressLine1>201 GOLDEN LANE</datatypes:AddressLine1>
<datatypes:AddressLine2>APT 204</datatypes:AddressLine2>
<datatypes:City>CINCINNATI</datatypes:City>
<datatypes:StateProvince>OH</datatypes:StateProvince>
<datatypes:PostalCode>45233</datatypes:PostalCode>
<datatypes:CountryCode>US</datatypes:CountryCode>
</structures:Address>
</script:Patient>
<script:Pharmacy>
<structures:Identification>
<datatypes:NCPDPID>7701631</datatypes:NCPDPID>
<datatypes:NPI>7878787879</datatypes:NPI>
</structures:Identification>
<structures:BusinessName>CINCINNATI PHARMACY</structures:BusinessName>
<structures:Address>
<datatypes:AddressLine1>100 OMNIBUS LANE</datatypes:AddressLine1>
<datatypes:City>CINCINNATI</datatypes:City>
<datatypes:StateProvince>OH</datatypes:StateProvince>
<datatypes:PostalCode>45202</datatypes:PostalCode>
<datatypes:CountryCode>US</datatypes:CountryCode>
</structures:Address>
<structures:CommunicationNumbers>
<datatypes:PrimaryTelephone>
<datatypes:Number>8595559000</datatypes:Number>
</datatypes:PrimaryTelephone>
</structures:CommunicationNumbers>
</script:Pharmacy>
<script:Prescriber>
<structures:Identification>
<datatypes:NPI>666666666</datatypes:NPI>
</structures:Identification>
<structures:Name>
<datatypes:LastName>JONES</datatypes:LastName>
<datatypes:FirstName>MARK</datatypes:FirstName>
</structures:Name>
<structures:Address>
<datatypes:AddressLine1>211 CENTRAL ROAD</datatypes:AddressLine1>
<datatypes:City>CINCINNATI</datatypes:City>
<datatypes:StateProvince>OH</datatypes:StateProvince>
<datatypes:PostalCode>45202</datatypes:PostalCode>
<datatypes:CountryCode>US</datatypes:CountryCode>
</structures:Address>
<structures:CommunicationNumbers>
<datatypes:PrimaryTelephone>
<datatypes:Number>8595558800</datatypes:Number>
</datatypes:PrimaryTelephone>
</structures:CommunicationNumbers>
</script:Prescriber>
<script:MedicationPrescribed>
<structures:DrugDescription>LOVENOX 40 MG PER 0.4 ML PREFILLED SYRINGE</structures:DrugDescription>
<structures:DrugCoded>
<datatypes:ProductCode>
<datatypes:Code>58016487201</datatypes:Code>
<datatypes:Qualifier>ND</datatypes:Qualifier>
</datatypes:ProductCode>
<datatypes:Strength>
<datatypes:StrengthValue>100</datatypes:StrengthValue>
<datatypes:StrengthForm>
<datatypes:Code>C42945</datatypes:Code>
</datatypes:StrengthForm>
<datatypes:StrengthUnitOfMeasure>
<datatypes:Code>C42576</datatypes:Code>
</datatypes:StrengthUnitOfMeasure>
</datatypes:Strength>
<datatypes:DrugDBCode>
<datatypes:Code>854236</datatypes:Code>
<datatypes:Qualifier>SBD</datatypes:Qualifier>
</datatypes:DrugDBCode>
</structures:DrugCoded>
<structures:Quantity>
<datatypes:Value>30</datatypes:Value>
<datatypes:CodeListQualifier>38</datatypes:CodeListQualifier>
<datatypes:QuantityUnitOfMeasure>
<datatypes:Code>C48540</datatypes:Code>
</datatypes:QuantityUnitOfMeasure>
</structures:Quantity>
<structures:DaysSupply>30</structures:DaysSupply>
<structures:Diagnosis>
<structures:ClinicalInformationQualifier>1</structures:ClinicalInformationQualifier>
<structures:Primary>
<datatypes:Code>E11.9</datatypes:Code>
<datatypes:Qualifier>ABF</datatypes:Qualifier>
<datatypes:Description>DIABETES MELLITUS</datatypes:Description>
</structures:Primary>
</structures:Diagnosis>
<structures:Sig>
<structures:SigText>INJECT 40 MG SUBCUTANEOUSLY ONCE DAILY</structures:SigText>
</structures:Sig>
</script:MedicationPrescribed>
<script:Provider>
<structures:Identification>
<datatypes:NPI>7777777777</datatypes:NPI>
</structures:Identification>
<structures:Name>
<datatypes:LastName>WEISS</datatypes:LastName>
<datatypes:FirstName>TERRY</datatypes:FirstName>
<datatypes:Suffix>RN</datatypes:Suffix>
</structures:Name>
<structures:CommunicationNumbers>
<datatypes:PrimaryTelephone>
<datatypes:Number>8595559880</datatypes:Number>
</datatypes:PrimaryTelephone>
<datatypes:Fax>
<datatypes:Number>8595559770</datatypes:Number>
</datatypes:Fax>
</structures:CommunicationNumbers>
</script:Provider>
</transport:PAInitiationRequest>
</transport:Body>
</transport:Message>