Understanding ePA Status Changes

It's important for both providers and staff to monitor the ePA queue daily to verify status changes. To learn how to open the ePA queue, go to Opening the ePA Queue.

This topic covers how to respond to some of the most common ePA statuses.

If the ePA status reads "Action Required", you'll need to submit additional information before the authorization process can move forward. The Action column provides links to appropriate actions based on the status of the authorization.

To respond:

  1. Locate the prior authorization you're looking for and select View ePA.
  2. Review the ePA Instructions and proceed as instructed by the payer.
  3. If clinical questions are required, click Start Questions.

  4. Answer the Clinical Questions from Surescripts.

    Depending on the answers you submit, additional questions and comments may be required.

  5. Click Save when you're finished.

    You can save and come back to finish unanswered questions later if you need to.

  6. Add an attachment, if necessary, by selecting Attach Visit or Add Patient Attachment.

    You can only attach one visit or patient attachment.

  7. Select the check bubble for the visit or attachment you want to attach.

  8. Click Attach.

    You can view and/or remove the attachment from within the ePA Summary.

  9. When you're finished answering clinical questions and adding an attachment, click Submit ePA within the ePA Summary.

    You won't be able to see this button if there are still unanswered clinical questions.

Once a prior authorization has been approved, you can ePrescribe, print, or void the prescription from the Rx screen. If you want to review the effective date and expiration date of the authorization, you can select View ePA.

There are times when a payer authorizes a medication with restrictions. For example, the payer may limit the amount of pills to be dispensed or specify that the prescription must be filled through a particular pharmacy. If the authorization is Approved with Appeal, you can submit an appeal with your justification(s) as to why those restrictions should be waived. Likewise, if an authorization is Denied with Appeal, you can submit an appeal to have it approved.

To submit an appeal:

  1. Locate the prior authorization you're looking for and select Appeal ePA.
  2. Enter the reason for appeal.
  3. Click Request Appeal.

Full List of ePA Statuses

The following list explains what each ePA status means.

Status Meaning

Initiated

A prior authorization request has been submitted to the payer.

Not Initiated

Action is required to Initiate ePA or Override ePA.

Action Required

Payer has received the request, and prior authorization must be completed with clinical questions or ePA instructions.

Approved

The ePA has been approved by the payer.

Approved with Appeal

The ePA has been approved, and an appeal can be submitted.

Overridden

The ePA has been refused by the user.

Submitted

The ePA has been processed with clinical questions and ePA instructions addressed.

Denied

The ePA has been denied by the payer.

Denied with Appeal

The ePA has been denied, and an appeal can be submitted.

Canceled

The ePA has been canceled by the user.

Closed

The ePA has been closed. If the payer or Surescripts closes an ePA, view the ePA Instructions for further details. Once an ePA is closed, the prescription will be released to the Rx queue, at which time you'll be able to ePrescribe, print, or void the prescription.

Closed PDR Received

The ePA process cannot be completed within Eyefinity EHR, but a link within the ePA instructions will provide you access to a form you can use to advance the ePA process manually. View the ePA to see the ePA instructions.

None Available

There is no ePA available to process.

View Error

There is an error in the authorization.

Full List of ePA Actions

The Action column is contextual. It provides links to appropriate actions based on the status of the authorization. This table lists all possible actions regardless of status.

Select this link… To perform this action…
Initiate ePA

Request authorization from the patient's primary insurance
View ePA

Review the ePA summary
Appeal ePA

Appeal a denied or approved authorization
Override ePA

Bypass the ePA process due to medication's being cosmetic or self-pay
Cancel ePA

Stop the authorization process
Change the Rx Plan

Select the patient's secondary insurance for authorization