Managing Electronic Prior Authorizations

NextGen® Enterprise EHR Help

Electronically Submit a Prescription

In NextGen® Enterprise EHR, open the Medications module. Select a medication. On the medication details toolbar, select Send. Note: If the pharmacy associated with the medication is hidden, a message appears with an option to select another pharmacy. The Send Prescription window opens. For multiple medications, all associated pharmacies must be active before you can send the medications. Only providers who are enrolled in ePrescribing and assigned a Surescripts Provider Identifier (SPI) can submit prescriptions electronically. If you are not enrolled, a message appears indicating that no SPI is allocated. You can contact your system administrator to check your enrollment details and see the Select a Supervising Physician section in File Maintenance. Optional: To remove a hidden pharmacy message from the Alerts section, select a destination pharmacy that is not hidden in the Destination field or through the Manage Patient Pharmacies link. From the Destination list, select a pharmacy. No

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

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

Managing Electronic Prior Authorizations

Recommendations

Electronically Submit a Prescription

Managing Electronic Prior Authorizations

Complete Electronic Prior Authorization Criteria

Initiate Electronic Prior Authorization Request

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

View Electronic Prior Authorization Note

Electronically Submit a Prescription

Managing Electronic Prior Authorizations

Complete Electronic Prior Authorization Criteria

Initiate Electronic Prior Authorization Request

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

View Electronic Prior Authorization Note