NCPDP • FAQs
What does each Transaction Response Status mean?
Why does it say my PA is approved when I reversed the PA?
What do the transaction codes stand for?
I billed an approved PA, why does it say that my authorization number is invalid?
Why do I have to use a TAR Attachment Form to send attachments?
How long does it take to adjudicate a PA?
How do I submit multiple services for the same patient?
Why did the screens change?
Effective March 21, 2005, the eTAR pharmacy application was changed
to reflect the HIPAA NCPDP 5.1 specifications. This was done to conform
to a federal mandate that all electronic Prior Authorization (PA) transactions
meet the NCPDP HIPAA guidelines. As NCPDP only regulates Pharmacy transactions,
all other eTAR service types will still be submitted using the standard
eTAR application. The pharmacy Treatment Authorization Request
(TAR) processing system will be enhanced to accept electronic prior authorization
transactions (via the CAL-POS network). The Point of Service (POS) network
solution (CAL-POS) interfaces with most software solutions currently used
to submit pharmacy claim transactions. Technical specifications for the
POS NCPDP prior authorization transaction are available on the Technical
Publications page.
What does each Transaction Response Status
mean?
There are five different Transaction Response Statuses available.
Captured (In Review): Indicates the service line was submitted correctly and has not yet been processed by the field office.
Rejected (Denied): Indicates the service line was denied or was not submitted to the field office for adjudication based on the reasons listed in the Message/Additional Message Information field.
PA Deferred: Indicates the service line was deferred until requested information is submitted.
Approved: Indicates the service line was approved and is now ready to be billed.
Dup of Capture: Indicates the request or reauthorization was already submitted.
What is a PA Reversal?
A PA Reversal is the new terminology for canceling a PA. Only
PAs that are in a “Captured” or “Approved” status can be reversed. PAs
that have a “Deferred” or “Rejected” status cannot be reversed.
Why does it say my PA is approved when I reversed
the PA?
When you reverse a PA, the PA is not actually deleted. The reversal is
submitted, and the NCPDP/eTAR system automatically adjusts the number
of units requested down to zero. If claims have already been paid against
an approved PA, the system reduces the approved units down to the number
of units already paid.
Refer to the Reversal (Cancel) module for more information.
What do the transaction codes stand for?
There are three different transaction codes that are used in the NCPDP/Medi-Cal
eTAR PA system.
P2 = PA Reversal (Cancel a PA). Refer to the Reversal
module.
P3 = PA Inquiry. Refer to the
Inquiry module.
P4 = PA Request Only. Refer to the Request
a New PA module.
I billed an approved PA, why does it say that
my authorization number is invalid?
The 10-digit authorization number that is generated when your PA is initially
submitted is not the final authorization number that you will use for
billing.
When the PA is approved, a new field titled PA Number - Assigned appears on the PA Response screen. This field completes the PA for billing purposes if your TAR was approved. The number in this field is 11 digits, made up of the 10-digit number received upon submission and a one-digit number that appears when the service is approved for billing. This 11-digit number is the final authorization number you will use for billing your approved service line.
Refer to the Inquiry module for more information about finding the PA Number - Assigned field.
Why do I have to use a TAR Attachment Form
to send attachments?
When attachments are submitted via fax, they cease to exist in
the paper world. When the fax goes through, it is received by a fax server–
a
computer that reads the information on the first page of the document.
If the first page is not the TAR Attachment Form, the attachment will
be rejected. It will not be uploaded to the PA/eTAR system.
Refer to the Quick Tips module for more information about completing and submitting the TAR Attachment Form.
How long does it take to adjudicate a PA?
Like paper TARs, the length of time it takes for a PA to be adjudicated
is dependent on the field office. Field office workload and staffing levels
determine adjudication time.
How do I submit multiple services for the same
patient?
After you have submitted a PA request for one service and received an
authorization number, click Add Another Service to Same Patient
to create an additional pharmacy service line on the same PA
number. You will only be able to create multiple service lines for the
same submitting provider and recipient numbers.
