Clear Approved Tasks from Prior Authorization Worklist

NextGen® Enterprise EHR Help

Appeal an Electronic Prior Authorization Denial

You can electronically appeal a PBM denial only if the denial response supports an appeal. The PBM could send a Deny response that would not allow you to appeal. If the appeal is successful, you will receive a new question set. Open Worklist. Electronic Prior Authorization Select the Prior Auth Denied task for the applicable patient. The PA Denied page displays the denial details. Note: If you select Acknowledge Denied PA, you will no longer be able to electronically appeal the denial. Electronic Prior Authorization Select Appeal. The Appeal page displays instructions to complete the appeal. Electronic Prior Authorization Select Appeal. Note: When the PBM responds, it could be with Denied, Deferred, Approved, or other response. If the PBM sends another question set, complete it and send it back to the PBM. If the PBM sends an Approved response, the Worklist displays ePA request task as Prior Auth Approved. Parent topic: Managing Electronic Prior Authorizations

NextGen® Enterprise EHR Help

View Prior Authorization Task History

Open the Electronic Prior Authorization window by doing one of the following: In the Medications module, select . On the View menu, select Manage ePA. Select the Task History tab. 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

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

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

Manage an ePA Action Required Task

From Clinical Tasking, you can directly access the various areas of the ePA process to manage electronic prior authorizations. Select a task that has a description that displays the status ePA Action Required. The task details opens. Task details Select Manage ePA. The system automatically accepts the task for you and opens the appropriate window for the Manage ePA process. The window that opens depends on the specific ePA task and the kind of action you need to take. Perform the necessary actions in the Manage ePA window. Parent topic: ePA from the Workflow Module Inbox

Clear Approved Tasks from Prior Authorization Worklist

Recommendations

Appeal an Electronic Prior Authorization Denial

View Prior Authorization Task History

Complete Electronic Prior Authorization Criteria

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

ePA from the Workflow Module Inbox

Manage an ePA Action Required Task

Appeal an Electronic Prior Authorization Denial

View Prior Authorization Task History

Complete Electronic Prior Authorization Criteria

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

ePA from the Workflow Module Inbox

Manage an ePA Action Required Task