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Starting A Request
Select your patient, search for the drug, and click on the appropriate strength.
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Click on Request Prior Authorization to start the patient's PA.
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Selecting The Form
If we can auto-select the correct form, you will be directed to a page where you can complete the request. In some cases, you may be asked to review a list of Prior Authorizations to determine the most appropriate for your patient.
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Completing The Request
Most of the Patient details, Prescriber details, and some Medical details will be auto-filled. Complete any missing information and the Rationale section, if needed. We recommend clicking Save Changes on the top left side of the request whenever you complete a section of the form.
Required And Important Tags
The red Required tags indicate fields used by the plan or another healthcare provider to identify the patient and to make a determination.
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The orange Important tags indicate fields most commonly used by the plan to make an accurate determination. We highly recommend completing these fields before sending the request to the plan.
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Sending A Request To The Plan
Once the PA request is complete, if available click Send to Plan in the left panel. Plans enabled with electronic Prior Authorization (ePA) may then electronically request more information, or send a determination back to you electronically. If Send to Plan is not available, click Fax Request, then chose To plan as the destination. The plan's fax number will auto-fill for most requests.
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If Send to Plan is not available, click Fax Request, then chose To plan as the destination. The plan's fax number will auto-fill for most requests.
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Some PA's require an authorized signature before they can be faxed to the plan. Requests can be signed electronically using the mouse. You can sign the request on the dotted line by holding down the left mouse button and moving the curser like a pen to form a signature. You may click Reset and re-sign until you are content with the signature.
After confirming the office contact information and applying the signature (if needed), click the Fax button at the bottom of the page. Once a prior authorization request has been successfully faxed to the plan, they will contact you directly with their determination, usually by fax.
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Downloading/Printing A Request
If you need a copy of the PA for your records, it can be downloaded and printed out. On the left side of the PA Request, click Download/Print. The file will open in a PDF that you can view and print.
Using Archive
You should archive requests when the plan has sent notification of the determination.
To Archive a form:
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Go to your Dashboard and find the request you want to archive
Open the request and click the Archive button on the left side.
Choose an outcome of Approved, Denied, Not sent to plan, or Don't know outcome. If Denied is chosen, a dropdown menu will appear to select the reason for the denial. If the given reasons aren't sufficient, you may type the reason in the Other field. A dropdown menu will also appear when Not sent to plan is selected.
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Dashboard
All PA requests are stored on the Dashboard. The Dashboard can be located by clicking the Prior Auth link at the top of the screen, or the Prior Auth link on the top left corner of a patient's specific page.
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You can filter PAs using the folders on the left side of the Dashboard. All PAs are stored in the folder marked All. PAs that have been started, but not submitted to the plan are located in the Incomplete folder. PAs that have been submitted to the plan and the plan has responded needing more information or with the determination are in the New folder. PAs that have been sent to the plan and have not received a response yet will live in the Pending folder. Finally, once the PA receives a determination and is archived, it will be moved into the Archived folder.
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