Upload Electronic Prior Authorization Documents Within the ePA Accelerator

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

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

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

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

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 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

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Before you begin

Recommendations

View the Downloaded ePA Documents Within the Medication Grid

Initiate Electronic Prior Authorization Request

Accept and Download ePA Documents in the ePA Accelerator

Complete Electronic Prior Authorization Criteria

Appeal an Electronic Prior Authorization Denial

View Electronic Prior Authorization Note

View the Downloaded ePA Documents Within the Medication Grid

Initiate Electronic Prior Authorization Request

Accept and Download ePA Documents in the ePA Accelerator

Complete Electronic Prior Authorization Criteria

Appeal an Electronic Prior Authorization Denial

View Electronic Prior Authorization Note