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PA Status Information

Prior authorization (PA) status codes displayed on the Provider Healthcare Portal (Portal) comply with the Health Insurance Portability and Accountability Act (HIPAA) 278 transaction standards and provide only a high-level, standardized description of the actual working status of the PA request. PA status information reported through the Interactive Voice Response (IVR) system is also only a high-level description. PA notification letters mailed to the provider and member, however, continue to provide the more detailed administrative working status that more clearly explains the current status of the PA request.

The following table provides a crosswalk between the high-level standard responses reported on the Portal, on 278 transactions, and through the IVR with the more detailed administrative working statuses associated with each standard response. Providers should use this table to help them understand the standardized HIPAA-compliant status responses they receive when conducting a PA inquiry. Providers should refer to their PA notification letters for additional information regarding the more detailed working status of a PA request.

HIPAA-Compliant PA Status Responses Crosswalked with Associated Administrative Working Statuses

PA Status in the Portal Action Code on the 278 PA Transaction PA Status in the IVR PA Status in Decision Letters (Clarification) PA Status Code
Certified in Total A1 "...is approved." Approved A
Appr Thru Admin Rev (Approved through administrative review) Y
Appr/Contin of Serv (Approved for continuation of service) F
Auto Appr After 10 (Automatically approved after 10 days) Z
Dec Overturn by ALJ (Decision overturned by administrative law judge) C
Dis No Hearing Appr (Appeal dismissed, no hearing, request approved) S
Non-Cov Code Approve (Noncovered code, approved) B
 
Modified A5 "...is modified." Dis No Hearing Mod (Appeal dismissed, no hearing, request modified) T
Mod Thru Court (Decision modified through court action) V
Modified M
Mod/Contin of Serv (Modified for continuation of service) G
Mod Thru Admin Rev (Modified through administrative review) X
 
No Action Required NA "...is not assigned; request does not require PA." No PA required N
No PA Req for PMP (No PA required when requested by a PMP) O
 
Not Certified A3 "...is denied." Dis No Hearing Den (Appeal dismissed, no hearing, request denied) U
Dec Upheld by ALJ (Decision upheld by administrative law judge) W
Denied D
Den/Contin of Serv (Denied for continuation of service) H
Incorrect PMP Q
Non-Cov Code Denied (Noncovered code, denied) I
"...is rejected." Rejected R
 
Pended A4 "...has been suspended for further information." Suspended (Suspended for further review) K
"...is pending written documentation." Pending (Pending receipt of required information) P

 

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