In this Quick Reference Guide, we will learn how to initiate an Electronic Prior Authorization (ePA) request from the Medications Module. This guide assumes that the user has a basic understanding of how to add, and renew medications.
Important Note
Before trying to initiate an ePA Request, it is important for you to know the following:
- Once you initiate ePA for a medication, the medication cannot be modified.
- When you renew a medication, prior authorization information from the previous medication instance is not transferred to the new medication.
- Medications prescribed elsewhere cannot be processed.
- Make sure that no one has sent a previous request for the medication.
- Generic forms of medications do not require prior authorizations.
PA Required
After searching for and selecting a medication for the patient; PA Required displays in the Prior Auth Status column for medications requiring prior authorization. PA will display in the Coverage column for medications needing prior auth when using the Formulary.
Ensure that the Prior Auth Status, Prior Auth, and Prior Auth ID Column preferences are set in the Medications Module. If the columns are not visible then contact your Super User for assistance.
Initiating Electronic Prior Authorization Request
Perform the following steps to initiate the ePA request:
- Click Accept to activate medication.
- Click the Initiate ePA active text link.
The Initiate ePA link will remain disabled if initiated successfully.
Additional Notes
If the standard Medication default search was used to select the medication instead of the Formulary. The Formulary Selection window displays so you can select a plan.
If you then select to Continue w/o Formulary, a message displays that the ePA process cannot continue without an eligible payer. You then must either run Rx Eligibility or prescribe using the Formulary.
Action Required
If the Authorization Status of a medication displays Action Required, there is either a question or message that has been sent regarding the authorization. There are two ways to manage the ePA:
1. Click Manage ePA to open the Electronic Prior Authorization window in Patient Mode.
The window displays a Worklist of prior authorization tasks related only to the selected patient.
2. Click Manage ePA from the View menu to open the Electronic Prior Authorization window in Provider Mode.
The window displays a Worklist of all prior authorization tasks associated with the providers name selected at the top of the NextGen EHR Window.
Complete Prior Auth Criteria
Click the Complete Prior Auth Criteria Task link to Start process.
After completing the questionnaire, click the Submit button to complete the Prior Auth Criteria Task.
Conclusion
When the Prior Authorization Status of the medication changes to Approved, the medication can then be sent to the pharmacy.
If you print the prescription, the Prior Authorization case number will be included on the prescription.
