Electronic Prior Authorization Info on RxPrint and RxFax Reports

NextGen® Enterprise EHR Help

View the eRx Status for a Medication with a Prior Authorization Request

If you sent an electronic prior authorization request through the Initiate ePA link, you can track the eRx status of the medication. From the View menu, select eRx Status. The eRx Status window opens. eRx Status For Message Type, select PA Initiation Request. Enter any remaining criteria as needed, and then select Search. Parent topic: Managing Electronic Prior Authorizations

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

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 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

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

Electronic Prior Authorization Info on RxPrint and RxFax Reports

Recommendations

View the eRx Status for a Medication with a Prior Authorization Request

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

View Electronic Prior Authorization Note

Appeal an Electronic Prior Authorization Denial

View the Downloaded ePA Documents Within the Medication Grid

Accept and Download ePA Documents in the ePA Accelerator