HITSP Pharmacy to Health Plan Authorization Request and Response Transaction

July 8, 2009

Version 1.1

HITSP Pharmacy to Health Plan Authorization Request and Response Transaction

HITSP/T79

Healthcare Information Technology Standards Panel (HITSP) logo

Submitted to:

Healthcare Information Technology Standards Panel

Submitted by:

Administrative and Financial Domain Technical Committee

Document Change History

Version Number	Description of Change	Name of Author	Date Published
0.0.1	Review Copy	Administrative and Financial Domain Technical Committee	September 26, 2008
0.0.2	Review Copy	Administrative and Financial Domain Technical Committee	December 10, 2008
1.0	Released for Implementation	Administrative and Financial Domain Technical Committee	December 18, 2008
	Template V2.5	Project Team	June 30, 2009
1.0.1	Review Copy	Administrative and Financial Domain Technical Committee	June 30, 2009
1.1	Released for Implementation	Administrative and Financial Domain Technical Committee	July 8, 2009

Table of Contents

1.0 Introduction. 5

1.1 Overview. 5

1.2 Copyright Permissions. 5

1.3 Reference Documents. 5

1.4 Conformance. 6

1.4.1 Conformance Criteria. 6

1.4.2 Conformance Scoping, Subsetting and Options. 6

2.0 Transaction Definition. 7

2.1 Context Overview. 7

2.1.1 Transaction Constraints. 7

2.1.2 Interfaces. 8

2.1.3 Interface Interactions. 8

2.1.4 Pre-conditions. 9

2.1.4.1 Process Triggers. 9

2.1.5 Post-conditions. 9

2.1.5.1 Required Output 9

2.1.6 Data Flows. 9

2.2 List of HITSP Constructs. 9

2.2.1 Construct Dependencies. 9

2.2.2 Additional Constraints on Required Constructs. 10

2.3 Standards. 10

2.3.1 Regulatory Guidance. 10

2.3.2 Selected Standards. 11

2.3.3 Informative Reference Standards. 11

3.0 Appendix. 12

4.0 document updates. 13

4.1 December 10, 2008. 13

4.2 December 18, 2008. 13

4.3 June 30, 2009. 13

4.4 July 8, 2009. 13

Figures and Tables

Figure 2-1 Pharmacy to Health Plan Authorization Request and Response. 8

Table 1-1 Reference Documents. 6

Table 2-1 Transaction Constraints. 7

Table 2-2 Interfaces. 8

Table 2-3 Interface and Transaction/Content Constraints. 8

Table 2-4 Pre-conditions. 9

Table 2-5 Process Triggers. 9

Table 2-6 Post-conditions. 9

Table 2-7 Required Output 9

Table 2-8 List of HITSP Constructs. 9

Table 2-9 Construct Dependencies. 10

Table 2-10 Additional Constraints on Required Constructs. 10

Table 2-11 Regulatory Guidance. 10

Table 2-12 Selected Standards. 11

Table 2-13 Informative Reference Standards. 11