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.
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.
Select Appeal.
The Appeal page displays instructions to complete the appeal.
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.
