Appeal an Electronic Prior Authorization Denial

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

Clear Approved Tasks from Prior Authorization Worklist

As you manage electronic prior authorizations, the Worklist page containing the tasks can become long. You can reduce the number of tasks by removing the approved tasks from the list. Open the Electronic Prior Authorization window. Electronic Prior Authorization In the Task column, select the Prior Auth Approved link. The PA Approved page displays the approval information. Electronic Prior Authorization Select Acknowledge Approved PA. The Worklist page no longer lists the task. Electronic Prior Authorization Parent topic: Managing Electronic Prior Authorizations

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

NextGen® Enterprise EHR Help

Accept and Download ePA Documents in the ePA Accelerator

Before you begin You must be enrolled for Electronic Prior Authorization (ePA) in System Administrator. When a pharmacy benefit manager (PBM) sends a document within the ePA accelerator, you can accept and download the attachment and view it within the patient's encounter in NextGen® Enterprise EHR. Open Medications module. Select a patient with previous ePA request. Select Manage ePA. The Electronic Prior Authorization window opens. Select the Prior Auth Denied task. The Electronic Prior Authorization window opens. Select ACCEPT AND DOWNLOAD. Note: You cannot download a patient's ePA document from View > Manage ePA . You can download a patient's ePA document from Inbox > Clinical Tasking and from Manage ePA in the Medications module. You can view the downloaded document in the encounter. Select the ePA downloaded document. The ePA document opens in a new tab. If you want to download a document again, an alert message appears stating that the document is already downloaded. Parent topi

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

Appeal an Electronic Prior Authorization Denial

Recommendations

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Clear Approved Tasks from Prior Authorization Worklist

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox

Accept and Download ePA Documents in the ePA Accelerator

View Electronic Prior Authorization Note

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Clear Approved Tasks from Prior Authorization Worklist

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox

Accept and Download ePA Documents in the ePA Accelerator

View Electronic Prior Authorization Note