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

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

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

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

Clear Approved Tasks from Prior Authorization Worklist

Recommendations

Appeal an Electronic Prior Authorization Denial

View Prior Authorization Task History

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox

Clear Approved Tasks from Prior Authorization Worklist

View Prior Authorization Task History

Clear Approved Tasks from Prior Authorization Worklist

Appeal an Electronic Prior Authorization Denial

View Prior Authorization Task History

Complete Electronic Prior Authorization Criteria

ePA from the Workflow Module Inbox

Clear Approved Tasks from Prior Authorization Worklist

View Prior Authorization Task History