Overview
What is electronic prior authorization (ePA) for prescriptions?
The electronic prior authorization (ePA) feature lets prescribers and their Prescription Delegates initiate prior authorization requests with the patient’s Pharmacy Benefits Manager (PBM) right from the Prescription Form, then manage and track these requests in the ePA Worklist.What are the benefits of electronic prior authorization for prescriptions?
Electronic prior authorization (ePA) significantly reduces the traditional dependence on pharmacy-initiated prior authorization processes and third-party ePA portals like CoverMyMeds. ePA lets you:- Initiate a prior authorization request before sending the ePrescription to the pharmacy.
- Avoid delays caused by waiting for pharmacy-initiated requests.
- Track and complete prior authorization tasks via a new ePA Worklist report.
Which patients qualify for electronic prior authorizations for prescriptions?
ePAs are supported for patients with active prescription benefits coverage with a PBM that supports ePA through Surescripts, Elation’s ePrescribing partner.Workflow Instructions
Initiating an electronic prior authorization request
Electronic prior authorization (ePA) requests are initiated directly from Elation’s Prescription Form.A patient’s prescription coverage status is determined by their Pharmacy Benefits Manager (PBM), and the coverage information displayed reflects what the PBM provides. If you believe the patient has active coverage but it’s not showing, review their Legal First Name, Legal Last Name, Date of birth, Sex at birth, full Address, and Primary Phone Number to ensure the details in Elation match what the PBM uses to identify the patient.If the patient’s PBM doesn’t support electronic prior authorizations, hovering over the Electronic Prior Authorization field will show the message: “Electronic prior authorization is not supported by the patient’s insurance provider.”
After the ePA is initiated, the Electronic Prior Authorization field becomes locked and displays ePA initiated. This status is also recorded in the Chronological Record, but it will not update as the ePA request progresses.
If an ePrescription has already been sent, create a new prescription draft for the same medication to initiate the ePA request, and then delete the draft once the request has been submitted.
Managing electronic prior authorization requests
Viewing the ePA Worklist Report
Third-party cookies must be enabled on your web browser to view the ePA Worklist . Click here for step-by-step instructions .
Viewing the worklist
The Worklist section shows all requests that need your attention. You can view and sort requests by the following criteria:-
- Task required
- Patient’s name
- Patient’s date of birth
- PA due date
- PA created dates
- Medication description details
- Use the Filter to narrow results by any of the worklist criteria.
- Click Clear All to remove any filters.
- Sort any column by clicking the sort icon.
- Refresh the worklist to see the updates using the refresh icon.
Viewing task history
The Task History section shows all in progress requests as well as completed or closed requests that you’ve acknowledged.- View requests based on any of the following criteria:
- Status
- Provider
- Patient’s name
- Patient’s date of birth
- PA created date
- Medication description details
- Sort any column by clicking the sort icon.
- Refresh the worklist to see the updates using the refresh icon.
- Use the Filter to narrow results by any of the worklist criteria.
- Click Clear All to remove any filters.
Managing prior authorization tasks
Completing prior authorization criteria
The PBM may not approve your request if you do not answer all related questions.
- Click Next to proceed to the next question.
- Click Back to return to a previous question.
- Click Skip to Submit to go straight to the summary screen.
The PBM may not approve your request if you do not answer all related questions.
- Click Options -> Start Questionnaire Over to clear your progress and return to the first question.
- Click Options -> Go to Worklist to return to the worklist without submitting your answers.
- Click Options -> Go to Task History to go to the Task History section without submitting your answers.
- Click Options -> Cancel Prior Authorization to cancel your request.
Additional comments and/or attachments may result in a manual request review which may result in slower response times.
Canceling an ePA request
This marks the task as canceled and moves it to the Task History section.
Appealing a denied request
Not all PBMs support electronic appeals. If the instructions below aren’t available for a denied request, it means the PBM doesn’t support electronic appeals, and you’ll need to contact them directly to appeal the decision.