EHI Export

Escribe ePA

The TruBridge EHR platform Electronic Prior Authorization file output format.

Table of contents

1. The ePA file naming scheme

2. The detailed file format definition

File Naming Scheme:

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

Detailed File Format:

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>