Enhanced Electronic Prior Authorization (EPA)

Electronic Prior Authorization (EPA) has been redesigned to streamline the process of submitting prior authorization requests for your patients' prescriptions. Here's what's new!

  • Set priority for urgent requests
  • Prior authorization requests are automatically initiated for medications that may require it
  • Question sets can be accessed and completed from the prescription preview screen
  • Answers are pre-populated if the information is already in the patient's chart
  • Attach documents to the question set
  • Prescriptions are held until the EPA is approved to mitigate confusion and prevent delays at the pharmacy
  • The EPA worklist is combined with specialty enrollment tasks on the prescriber dashboard to improve visibility and task management
  • Third-party processing and built-in URL links allow more prior authorizations to be completed electronically
  • Payers can respond to requests as Partially Denied, which indicates that the prior authorization has been approved by the payer but may be limited by pharmacy type, quantity, days supply, number of cycles, and/or number of refills

Set the EPA priority

To expedite the EPA, check the EPA Request box on the View/Edit Prescriptions screen while writing your prescription. Not all prescriptions will require prior authorization, but selecting this option will include the priority when the EPA process is initiated. If the request is not urgent, do not check the box.

mceclip1.png

Initiate the EPA process

A combination of the patient's formulary and real-time prescription benefit (RTPB) information is used to automatically initiate EPA for medications that require it. This is completed behind the scenes after a pharmacy has been selected for the prescription and that pharmacy checks to see if the PBM/payer requires prior authorization for the prescribed medication.

If prior authorization is required, this will be indicated on the prescription preview screen.

mceclip2.png

Answer the question set

Click Start to open the question set from the PBM or health plan.

mceclip3.png

Click Complete Prior Auth Criteria.

mceclip14.png

Click Start.

mceclip15.png

Complete the questions returned by the payer.

mceclip11.png

If any of the information requested is already available within the RXNT patient chart, it will be pre-populated on the question set.

If the PBM or health plan does not support electronic prior authorizations, a URL will be provided to complete the prior authorization request outside of RXNT.

 Prescriptions will not be held when the prior authorization is completed outside of RXNT.

Click Send closed BY response.

mceclip16.png

Click View PA Form. The form will open in a new tab to be completed outside of RXNT.

mceclip17.png

Rx Tasks

After completing the question set, close the popup to return to the prescription preview screen, then click Send

mceclip3.png

You will be directed to the Rx Tasks tab of the prescriber dashboard where prescriptions awaiting prior authorization are held. Any prescriptions that did not require prior authorization will be sent directly to the pharmacy and will show up within the Recent tab on the prescriber dashboard as usual. 

mceclip2.png

EPA status

The status of the prior authorization can be found on the right. Additional details about the request status can always be accessed by clicking the task name in the first column.

mceclip3.png

Not started

The question set has not been completed. Click Complete to answer the questions and submit the request.
mceclip4.png

In Progress

The PBM or health plan is reviewing the request. No changes can be made to the prescription at this time.

Approved

The prior authorization request has been approved. Non-controlled prescriptions will be sent automatically to the pharmacy the morning after the EPA was approved. Click Send Rx to send the prescription sooner.

EPCS prescriptions will remain on the task list since the OTP must be entered before the prescription is sent to the pharmacy. Click Send Rx to send EPCS prescriptions to the pharmacy.
mceclip5.png

Denied

The prior authorization request has been denied so the prescription has not been sent to the pharmacy. A new prescription for a different medication can be generated, or click Send Anyway to transmit the prescription without prior authorization. 

 Sending a prescription without prior authorization may result in an additional cost for the patient.

Partially Denied

The prior authorization request has been approved by the payer, but with some limitations. Limitations may include pharmacy type, quantity, days supply, number of cycles, and/or number of refills. Click Edit Rx to make the appropriate changes to the prescription and send it to the pharmacy. 
mceclip6.png

Closed

Requests can be closed without approval for multiple reasons including a duplicate request, questions answered after the deadline for reply, and/or other reasons determined by the PBM or health plan. Click on the task name to see more detail about a closed request.

If the PBM or health plan does not support electronic prior authorization but offers a web-based PA form, the URL to access the form will be available by clicking on the task name. Automatic approval/denial will not be received in these cases, and the status of the request will remain closed.

Prior authorization renewal requests

When a prior authorization is expiring, the PBM or health plan may send an unsolicited question set to prevent a lapse in medication. These requests will be displayed in the Rx Tasks tab with a status of Not Started. Click Complete to provide the requested information and submit the request.

mceclip0.png

Canceling the EPA

An electronic prior authorization request can be canceled at any time by clicking on the task name.

When an EPA is canceled, the prescription will move to the Pending tab so that it can be Voided to remove or Approved to send it to the pharmacy. Click here for more details on pending prescriptions.

 Sending a prescription without prior authorization may result in an additional cost for the patient.

mceclip0.png

Still need help? Contact us!

Have a great idea? Tell us about it!

 

 

 

Was this article helpful?
0 out of 0 found this helpful