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.
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.
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.
To prevent accidental PHI exposure, you cannot select the Manage ePA menu item if you have any patient on your Exclusion list in the System Administrator application. However, you could still initiate ePA from within the Medication module.
In the Worklist tab, go to the Task column, select Complete Prior Auth Criteria.
Patient information appears including demographic and medication information.
Select Start.
You are prompted with a series of questions, one at a time.
Answer each question, and then select Next.
As you answer each question, a progress bar indicates how far you are along in the process.
Note: If you must interrupt the process, select Return to Worklist. The system saves your progress so that you can continue at a later time from where you left off. It starts over from the first question, but it remembers the answers so you do not have to re-answer each one.
When you complete the criteria, your responses display so you can review them and make changes as needed.
If you are satisfied with your answers, select Submit.
The Worklist displays again, and the prior authorization task you completed is no longer listed. In addition, the prior authorization status of the medication becomes In Progress, and the task is set to Completed in the Inbox.
When the prior authorization status of the medication changes to Approved, you can send the medication to the pharmacy. If you print the prescription, the prior authorization case number will be included on the prescription.
