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 for each medication.
- If the formulary search results include medications that require prior authorization, the Coverage column on the Medication Search window displays PA.
In the medication details section, select Accept.
The Initiate ePA link becomes available.
If the link is not available, hover over the link to view the reason. Some examples are:
- The provider is not enrolled in the ePA service level.
- ePA is not available for the medication because its status is Temporary.
Note: To prevent accidental Protected Health Information (PHI) exposure, the link is not available when the patient is on any user’s exclusion list in System Administrator. You may have to use another method, like phone calls or fax, to conduct the prior authorization.
In the Day Supply field, enter the value to display the estimated number of days the prescription will last excluding refills.
The value for Day Supply is calculated by dividing the prescribed quantity by the daily doses. The field supports up to three numeric values.
- If Quantity = 30, Sig states, "take one tablet per day", and Refills = 3, the Days Supply = 30
- If Quantity = 3, Sig states, "take one tablet every week", and Refills = 3, the Days Supply = 21
- If Quantity = 100 mL, Sig states, "5 mL twice daily" , and Refills = 0, the Days Supply = 10
Note: The Day Supply field is mandatory for initiating ePA requests.
To set a high priority for the ePA request, select the Additional Prescription Detail link and select the Expedited check box in the Additional Prescription Detail panel.

Note: The Standard check box is selected by default.
Select the Initiate ePA link.
The ePA is initiated for the medication.
If you have used a default search to select the medication instead of a formulary search, the Formulary Selection window opens where you can select a plan.

If you select Continue w/o Formulary, a message appears stating that the ePA process cannot continue without an eligible payer. You must either run the Rx eligibility, or prescribe using the formulary. The Initiate ePA link is not available until a receipt message is returned.

Note:
If the ePA initiation is successful, the Initiate ePA link continues to remain unavailable to prevent you from sending a second request for the same medication.

If the initiation fails, the application displays a message stating that the initiation request has failed. You can close the message by selecting OK. The Initiate ePA link then becomes available so that you can resolve the error and initiate an ePA again.

Initiate Electronic Prior Authorization Request

Before you begin

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