Using Electronic Prior Authorizations

Prior authorizations are one of the most time-consuming steps in the prescribing workflow - requiring prescribers and staff to respond to payer questions and track case statuses. Electronic prior authorizations (ePA) can be managed via a streamlined workflow directly from the ePrescribing desktop and only initiate when a prescription is created.

For instances that require a real-time prior authorization response, such as when a patient's insurance doesn't cover the prescription, a message displays that allows you to launch the worklist.

What do you want to do?

To launch the ePA worklist, select either of the two launch points on the ePrescribing home screen:

  • Click the mortar and pestle icon and select Prior Authorizations (ePA)
  • Click the main menu and select Prior Authorizations (ePA)

The worklist displays outstanding ePAs and can be narrowed by filters. Records with an Open status are listed first.

The Status column indicates the state of each prior authorization. Statuses include:

  • Open - requires user intervention
  • Pending - awaiting a response from the patient's plan
  • Submitted to Plan - records have been submitted and are awaiting a response
  • Response Received - records have received a response and have either been approved or denied
  • Approved - approved by the patient's plan
  • Denied - denied by the patient's plan
  • Canceled - canceled
  • Closed - closed

Additionally, you can complete the following actions for each prior authorization that appears in the worklist:

  • Answer Questions - launches the ePA workflow, where you can upload supporting documents and respond to payer questions to complete the request
  • Submission Details (eye icon) - opens a read-only summary of the case, including status, payer information, and case history
  • Cancel (X icon) - Cancels the request. Confirm before canceling, since this action cannot be undone. This action is not available for requests in a final status (approved, canceled, closed, denied).
  • Archive - Removes the request from the worklist. Confirm before archiving, since this action cannot be undone. This action is only available for requests in a final status (approved, canceled, closed, denied).
  1. Click Answer Questions.
  2. Click Choose File to upload supporting documentation.

    Once documents are uploaded, selecting Answer Questions triggers a feature that populates answers to the payer's clinical questions based on the uploaded documentation.

  3. Click Cancel and Continue to proceed directly to the Questions Set tab if you don't want to wait for pre-population.
  4. Review the responses to the questions if pre-populated, or enter them manually if not pre-populated.
  5. Click Submit Answers when finished reviewing.