Accept and Download ePA Documents in the ePA Accelerator

NextGen® Enterprise EHR Help

View the Downloaded ePA Documents Within the Medication Grid

Before you begin You can view and refer to the Electronic Prior Authorization (ePA) attachments from the patient's pharmacy benefit manager (PBM) within the medication grid in addition to the patient's encounters. Note: You must add the Prior Auth Document column from Medications module, by selecting Grid Preferences > Set Columns to Display > Medications View Preferences > Available Columns > Prior Auth Document to view the documents. Open NextGen® Enterprise EHR, and select a patient from the Patient Lookup window. Open Medications module. Select a patient with previous ePA request. Note: You can also open the downloaded document from the Encounter History tab. Select the medication submitted for ePA in the medication grid. Scroll to the Prior Auth Document column. Hover over the paper clip icon to check if an ePA Document tool tip is available. Right-click the selected medication in the medication grid. Select View ePA Document from the menu to view the associated ePA document. The

NextGen® Enterprise EHR Help

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Before you begin You must be enrolled for Electronic Prior Authorization (ePA) in System Administrator. Patient must have Rx eligibility. Patient must have an active pharmacy benefit manager(PBM) coverage. Note: The UPLOAD FILE is available only if the PBM requests for additional documents. You can send attachments electronically to the patient's PBM by selecting Manage ePA in the Medication module. You can send additional details to support a patient's prior authorization request only as PDF files. You can upload multiple PDF files for PARequest and PAAppealRequest messages through the ePA Accelerator. If you send multiple attachments, they are combined into one file, and arranged in the order of the files sent. The combined file has the same name as the first file of the attachment. CAUTION: The total file size must not exceed 18 MB. If the combined file size is larger than 18 MB, you cannot attach them and an exception is displayed. Open Medications module. Run the Rx eligibility fo

NextGen® Enterprise EHR Help

View Electronic Prior Authorization Note

You can view the Electronic Prior Authorization (ePA) note sent by the patient's Pharmacy Benefit manager (PBM) in the Medications module. Open NextGen® Enterprise EHR. Select a patient with previous ePA request from the Patient Lookup window. Open the Medications module. On the medication grid, right-click the medication for which ePA is initiated, and then select View PA Notes. The View PA Notes window opens displaying the ePA note sent by the patient's PBM. Note: The View PA Notes option is disabled when the PA note is not available. Parent topic: Managing Electronic Prior Authorizations

NextGen® Enterprise EHR Help

Initiate Electronic Prior Authorization Request

Before you begin The Initiate ePA link is available when you select a medication and the following criteria are met: You have permissions for the Initiate ePA security right. You have ePA enrollment for retail service level. Medication is not prescribed elsewhere for the patient. No one has sent previous prior authorization requests for the medication. Patient is not on any user’s exclusion or inclusion list in System Administrator. Patient has active Pharmacy Benefit Managers (PBM) coverage. You can initiate electronic prior authorization (ePA) request in the Medications module by selecting the Initiate ePA link. Open NextGen® Enterprise EHR. Select a patient from the Patient Lookup window. Open the Medications module. Search and select a medication for the patient. The Prior Auth Status column on the Medications module displays PA Required if the medication requires prior authorization. Note: If multiple medications on the encounter require prior authorization, you must initiate ePA

NextGen® Enterprise EHR Help

Complete Electronic Prior Authorization Criteria

When the prior authorization status of a medication is Action Required, the PBM has sent a question set or other message and a user with the permissions to manage ePA must take action. Medications Module You can manage ePA from one of the following: In the Medication module, select 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. Electronic Prior Authorization On the View menu, select Manage ePA to open the Electronic Prior Authorization window in Provider Mode. The window displays a Worklist of all prior authorization tasks associated with the provider name selected at the top of the NextGen® Enterprise EHR window. This option might be useful for someone, such as a nurse, who is responsible for handling all prior authorizations for multiple providers. Electronic Prior Authorization To prevent accidental PHI exposure, you cannot select the Manage ePA menu item if you have

NextGen® Enterprise EHR Help

ePA from the Workflow Module Inbox

When you set up Clinical Tasking for Electronic Prior Authorization (ePA), users receive tasks in their inbox that notify them of certain ePA status changes that they need to take action on. Tasks can be routed to a provider or to a workgroup depending on the setup. Having ePA tasks listed on the Clinical Tasking tab in Inbox helps prescribers and clinical staff monitor responses on prior authorization requests sent from NextGen® Enterprise EHR to the pharmacy benefits managers (PBMs). The responses can include status updates when a prior authorization request needs clinical questions answered or other prescriber input, as well as approvals and denials from the PBM. Having notifications sent to the inbox improves the efficiency of the ePA process by enabling you to manage some ePA actions without opening the Medications module each time you want to check an ePA status or take action. The ePA tasks have Action Required and Approved statuses. You can go directly from the task in the inbo

Accept and Download ePA Documents in the ePA Accelerator

Before you begin

Recommendations

View the Downloaded ePA Documents Within the Medication Grid

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

View Electronic Prior Authorization Note

Initiate Electronic Prior Authorization Request

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox

View the Downloaded ePA Documents Within the Medication Grid

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

View Electronic Prior Authorization Note

Initiate Electronic Prior Authorization Request

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox