Practice Fusion supports streamlined electronic prior authorizations (ePA) within your EHR, facilitating the exchange of information necessary to request coverage of a specific prescription drug under a patient’s pharmacy benefits.
Prior authorizations (PAs) may be triggered by sending an e-prescription (eRx) or by manually initiating a request to complete a prior authorization. Prior authorization forms can be completed and submitted by any member of the practice from the patient’s Timeline, the Prior authorization report, or the Tasks section of the EHR.
Manually generate a prior authorization
You have the option to manually initiate the prior authorization process by submitting a request to the patient’s payer for a prior authorization form. This can be performed from a patient’s chart or from the Prior authorizations report.
From a patient’s chart:
1. Add prior authorization. Select Add prior authorization from the Actions dropdown menu as shown in Graphic 1 below.
Graphic 1: Add prior authorization
2. Choose medication. Select a new medication or a medication from the patient’s eRx list (see Graphic 2 below). If the prior authorization is for a new medication, the Dispense, Unit, and Days Supply fields must be filled in. If the prior authorization is for a previously submitted eRx, these fields will auto-populate with details from the prescription.
Graphic 2: Fill out quantity fields
3. Request prior authorization. Fill out all required fields, then click Request PA as shown in Graphic 3 below. You will receive a notification that your prior authorization request has been sent. In the patient’s Timeline, the status will show as Awaiting PA form until a form has been received. Once a question set has been received, the status will change to Incomplete.
Graphic 3: Request PA
4. Complete and submit question set. Once a PA form has been received, a task will be created for you to fill out the question set. Read the instructions below to complete the question set and submit to the payer.
From Prior authorizations report:
1. Navigate to Prior authorizations report. Click Reports and then clicking Prior authorizations as shown in Graphic 4 below.
Graphic 4: Prior Authorizations in Report section
2. Add prior authorization. Click Add Prior Authorization (see Graphic 5 below).
Graphic 5: Add Prior Authorization from Report Section
3. Fill out required fields. Type in or select patient from dropdown menu (see Graphic 6 below). Then choose a medication and complete the remaining required fields.
Graphic 6: Select Patient
4. Request prior authorization. After filling out all required fields, click Request PA as shown in Graphic 7 below. You will receive a notification that your prior authorization request has been sent. In Prior authorizations report and Timeline, the status will show as Awaiting PA form. Once a question set has been received, the status will change to Incomplete.
Graphic 7: Request PA from Reports Section
5. Complete and submit question set. Once a prior authorization form has been received, a task will be created for you to fill out the question set. For instructions on how to complete the question set and submit to the payer, see How do I use electronic prior authorizations?
Physicians’ Desk Reference formsIf a Closed response is returned, it is because the payer does not support ePA. Surescripts partnered with Physicians’ Desk Reference (PDR) to provide prior authorization coverage for patients whose health plan does not support ePA. PDR provides a library of editable PDF prior authorization forms. A link to the PDR library will be displayed in the Notes from patient insurance section of the prior authorization details page. Click the link to access the prior authorization PDF via the PDR website. All actions taken in the PDR website are outside of the EHR and any completed forms should be downloaded or printed for your records. After filling out the PDF form, click Submit to Plan to submit the form via PDR to the patient’s payer. See How do I submit prior authorizations via Physicians' Desk Reference (PDR)?