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It is not possible to save a prior request (or an e-claim) if one of its activity has mandatory observation that is not selected by user. Observations are entered on Observations form. 
 

OBSERVATIONS FOR NON-DRUG PROCEDURES

Step 1. Click on Create New Prior Request button. 
       Electronic Prior Request - Authorization form opens. Patient Details tab is active.

Step 2. Go to Procedure Details tab, set:

    • Type = 3 – CPT code;
    • Procedure = 83036.


Step 3. 
Click on Update observations link label.
       Observations form opens. 

The following rules work on the form:

    1. Type is a drop-down list containing the following values: LOINC, Text.
    2. Code shows an observation code:
      • it is a drop-down list that contains LOINC codes mandatory for the selected CPT code;
      • it is a text box if CPT does not have mandatory LOINC codes, so user can enter any code.
    1. Value is a text box showing an observation value.
    2. Value Type shows an observation value type:
      • it is a drop-down list containing expected value type of LOINC code in case this observation code details are available;
      • it is a text box if this observation code details are not available;
      • for Text observation Value Type = Value by default, but can be changed if needed.

Type, Code, Value and Value Type are mandatory fields for observations. Several observations can be added. An observation can be deleted by pressing Delete button on the keyboard.
 

Step 4. Set observations details and click on OK button.
       Observations form closes. Data will be saved after the request is saved. 


OBSERVATIONS FOR TRADE DRUGS 

Step 1. Click on Create New Prior Request button. 
       Electronic Prior Request - Authorization form opens. Patient Details tab is active.

Step 2. Go to Procedure Details tab, set:

    • Type = 5 – Trade Drug code;
    • Procedure = 1101-6738-001.

 
Step 3. 
Click on Update observations link label.
       Observations form opens. 

The grid contains observations added automatically:

    1. Type shows an observation type. The column values are not editable.
    2. Code shows an observation code. The column values are not editable.
    3. Value shows an observation value. It is a text box available for editing.
    4. Value Type shows an observation value type. It is a drop-down list with predefined values or a text box available for editing (see the table).
       

Type

Code

Value

Value Type

Text

Refills (the number of times a drug may be refilled)

Default value: 0

 

Text

Dose

 

Drop-down list containing the values:
mg
mcg
ml

LOINC

3141-9 (patient weight)

 

kg

Text

Dosage Form (the form in which the drug is marketed for use)

 

 

Text

Route (the route of administration)

 

 

Text

Duration (the duration of the quantity to be dispensed at one time, excluding any refills; e.g. Duration = 1 month, Refills = 2 means that the drug is prescribed for three months)

 

Drop-down list containing the values:
minutes
hours
days
weeks
months
Default: days

Text

Frequency (the number of times the medication is prescribed to be administered during the period identified by ValueType)

 

 

An observation cannot be deleted.
 

Step 4. Set observations details and click on OK button.
       Observations form closes. Data will be saved after the request is saved. 

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