View the eRx Status for a Medication with a Prior Authorization Request

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

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

View Prior Authorization Task History

Open the Electronic Prior Authorization window by doing one of the following: In the Medications module, select . On the View menu, select Manage ePA. Select the Task History tab. Electronic Prior Authorization Parent topic: Managing Electronic Prior Authorizations

NextGen® Enterprise EHR Help

Electronic Prior Authorization Info on RxPrint and RxFax Reports

The RxPrint and RxFax reports display the ePA case number and the following prior authorization statuses: Requested Approved Denied. If the pharmacy is not electronic, it can still have access to the ePA case number as a reference to communicate with the PBM as needed. Rx Parent topic: Managing Electronic Prior Authorizations

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

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

View the eRx Status for a Medication with a Prior Authorization Request

Recommendations

Initiate Electronic Prior Authorization Request

View Electronic Prior Authorization Note

View Prior Authorization Task History

Electronic Prior Authorization Info on RxPrint and RxFax Reports

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Complete Electronic Prior Authorization Criteria

View the eRx Status for a Medication with a Prior Authorization Request

Initiate Electronic Prior Authorization Request

View Electronic Prior Authorization Note

View Prior Authorization Task History

Electronic Prior Authorization Info on RxPrint and RxFax Reports

Upload Electronic Prior Authorization Documents Within the ePA Accelerator

Complete Electronic Prior Authorization Criteria