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.
What happens if a patient’s health plan does not currently support ePA?
Surescripts has 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.
Follow the directions below to complete a prior authorization via PDR.
1. Initiate the prior authorization process. PAs may be triggered by sending an e-prescription (eRx) or by manually initiating a request to complete a prior authorization. If the patient’s insurance carrier is not currently enabled for ePA, then Surescripts will send back a response with a Closed status.
2. Review Closed PA. Select the PA with a Closed status from within Tasks, the patient’s Timeline, or within the PA reports section of the EHR (see Graphic 1 below).
Graphic 1: Closed Status in PA Report
3. Open the PDR library. Check the Notes from patient insurance section of the prior authorization details page for a URL link to the PDR library (see Graphic 2 below). Click on the link to access the PDR prior authorization form library. A new tab will open in your browser.
Graphic 2: PDR URL
Please note that on some occasions, a Closed response may be returned for reasons other than the patient’s health plan not supporting ePA. In these cases a PDR link will not be available.
3. Fill out the prior authorization PDF via the PDR website. Fill out the default form presented in the browser, or search for another form to complete. 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 (see Graphic 3 below) to submit the form via PDR to the patient’s payer.
Graphic 3: Submit to Plan