Enable Electronic Prior Authorization for the Enterprise

NextGen® Enterprise EHR Help

Grant User Security Rights for Initiating and Managing ePA

Only users in the user groups that have the appropriate security rights have access to ePA in the Medications module and can initiate requests. The users who initiate ePA can be different from the users who manage ePA. In the System Administrator application, select the user group, and then under the Rights tab, in Operations then go to Medications, set the Access Rights to Yes for the following security rights: Allow Access to Manage ePA enables users, such as providers or clinical users, to manage ePA messages that come from the pharmacy benefit manager (PBM), including answering questions sent by the PBM. Initiate ePA enables users to use the Initiate ePA link in the medication details to send a request for prior authorization. Parent topic: Electronic Prior Authorization Setup

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

Electronic Prior Authorization Setup

After you enable Electronic Prior Authorization (ePA) across the enterprise, you can control which users use it. ePA setup involves the following procedures: Enable ePA for the enterprise . Grant users permission to initiate and manage the ePA process. If necessary, modify the ePA Import processor in NextGen Communication Services. For more information, go to NextGen Healthcare Success Community, and download the latest NextGen® Communication Services Configuration Guide for NextGen ePrescribing. If you want the user to receive tasks in the Inbox when an ePA status update indicates user action is required, then in File Maintenance, select Providers master file then go to ePrescribing tab, assign a workgroup and the ePA category to the provider for the ePA Task Type. Note: When the ePA Task Type has a workgroup and the ePA task category selected, in the Provider Check window, the Workflow and Categories section displays the ePA Group and ePA Category fields. Enable Electronic Prior Auth

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

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

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

Enable Electronic Prior Authorization for the Enterprise

Recommendations

Grant User Security Rights for Initiating and Managing ePA

Enroll Provider in ePA at the Retail Service Level

Electronic Prior Authorization Setup

Managing Electronic Prior Authorizations

View Electronic Prior Authorization Note

Complete Electronic Prior Authorization Criteria

Grant User Security Rights for Initiating and Managing ePA

Enroll Provider in ePA at the Retail Service Level

Electronic Prior Authorization Setup

Managing Electronic Prior Authorizations

View Electronic Prior Authorization Note

Complete Electronic Prior Authorization Criteria