Electronic Prior Authorization Setup

NextGen® Enterprise EHR Help

Enable Electronic Prior Authorization for the Enterprise

Enabling Electronic Prior Authorization (ePA) for the enterprise allows users with the proper security rights to initiate ePA for a medication and to manage the ePA process. In the System Administrator application, open the ePrescribing universal preferences, and then set the Electronic Prior Authorization (ePA) Enable preference to True. By default, the preference is set to False. When the preference is set to False, the Initiate ePA link and Manage ePA button in the Medications module and in the View menu, the Manage ePA menu item are hidden from users. Parent topic: Electronic Prior Authorization Setup

NextGen® Enterprise EHR Help

ePrescribing Setup

Before you begin Before you use the NextGen® Enterprise EHR ePrescribing feature, the following ePrescribing setup procedures must be completed: Install NextGen® Communication Services (NCS). Enable Surescripts functionality in NCS. Note: Before you attempt to set up ePrescribing, you must contact NextGen Healthcare Support to install and configure NCS. Download the Surescripts pharmacies. Map unmatched pharmacies and add unmatched pharmacies as new. Check the pharmacy service level. Enroll the providers in the Surescripts network. Set up eRx permissions for the providers. Set up ePCS (Electronic Prescriptions of Controlled Substances) for authorized providers. Set up tabs and categories for eRx refills and eRx errors in the Workflow module's task list. Set up workgroups for eRx refills and eRx errors in the Workflow module. Assign each Surescripts-enrolled provider with an eRx-specific workgroup and task list category. Set up supervising physician. Set up multiple destinations. System

NextGen® Enterprise EHR Help

Enroll Provider in ePA at the Retail Service Level

To send electronic prior authorization requests, a provider must have Retail Service Level enrollment in ePA. In File Maintenance, Providers master file, select a provider. In the Modify Provider Information window, go to the ePrescribing tab, then navigate to the Retail Level Service Level section, select ePA. Note: ePA enrollment is not required for Mail-Order Service Level. Select open menu > Retail > Enroll or Update. Modify Provider Information Parent topic: Electronic Prior Authorization Setup

NextGen® Enterprise EHR Help

Managing Electronic Prior Authorizations

An electronic prior authorizations (ePA) is automatically initiated when you accept a medication and save it to the patient chart and one of the following conditions is met: If the selected medication requires a prior authorization through a Real-Time Prescriptions Benefits (RTPB) request. Note: The patient's Pharmacy Benefits Manager (PBM) must be enrolled into Real-Time Prescriptions Benefits. If the patient's formulary file indicates that a prior authorization is required for the selected medication. Note: If the automatic ePA initiation fails, the Initiate ePA link in the medication details section becomes available. You can also manually initiate an ePA for new and renewed medications in NextGen® Enterprise EHR. Additionally, you can do the following: Complete and submit the criteria to the PBM for review. View approval or denial responses. Initiate appeals, if required. View prior authorization transactions history. Note: If a medication requires prior authorization and you attem

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

Initiate Electronic Prior Authorization Request

Before you begin The Initiate ePA link is available when you select a medication and the following criteria are met: You have permissions for the Initiate ePA security right. You have ePA enrollment for retail service level. Medication is not prescribed elsewhere for the patient. No one has sent previous prior authorization requests for the medication. Patient is not on any user’s exclusion or inclusion list in System Administrator. Patient has active Pharmacy Benefit Managers (PBM) coverage. You can initiate electronic prior authorization (ePA) request in the Medications module by selecting the Initiate ePA link. Open NextGen® Enterprise EHR. Select a patient from the Patient Lookup window. Open the Medications module. Search and select a medication for the patient. The Prior Auth Status column on the Medications module displays PA Required if the medication requires prior authorization. Note: If multiple medications on the encounter require prior authorization, you must initiate ePA

Electronic Prior Authorization Setup

Recommendations

Enable Electronic Prior Authorization for the Enterprise

ePrescribing Setup

Enroll Provider in ePA at the Retail Service Level

Managing Electronic Prior Authorizations

Complete Electronic Prior Authorization Criteria

Initiate Electronic Prior Authorization Request

Enable Electronic Prior Authorization for the Enterprise

ePrescribing Setup

Enroll Provider in ePA at the Retail Service Level

Managing Electronic Prior Authorizations

Complete Electronic Prior Authorization Criteria

Initiate Electronic Prior Authorization Request