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Electronic Prior Authorization

 The Preferred Way of ePA

Improve your ePrescribing workflows with integrated Electronic Prior Authorization software

According to a recent study conducted by the AMA, providers spend nearly 13 hours per week on Prior Authorization activities. Time is money, but those manual processes of the past are changing with ePA.

Within your ePrescribing workflow, a few clicks will open direct communication to ePA approvers and increase patient safety with less interruption to needed therapies. Provider adoption of this enhanced service is on the rise and is one of the many embedded features of our integrated software platform.

*Source: AMA prior authorization (PA) physician survey (ama-assn.org)

Powerful Networks for Expanded Coverage

What is Electronic Prior Authorization?

Electronic Prior Authorization (ePA) represents the next level in the evolution of prior authorization technologies. Unlike basic PA, which involves manual work often completed by medical assistants or other clinical staff, ePA is fully automated, integrating seamlessly with EHR/EMR systems to provide real-time authorization decisions. This means that as soon as a healthcare provider prescribes a treatment, the ePA system immediately checks for insurance coverage and authorization requirements, submitting a request if necessary, and rapidly returning a decision.

ePA Reduces Complexities in Traditional Forms

The PA process is further complicated by the lack of a standardized form at the federal level, leading to variations in the forms used across different states. These forms can vary significantly in the amount of information and specific details they require, adding layers of complexity to the process. This variance is compounded by the fact that different medications or insurance plans may necessitate differing levels of detail.

Information Typically Required in PA Forms:

Healthcare providers must meticulously gather and utilize patient information to determine the most appropriate care pathway. The completion and submission of PA requests can then be carried out through various means, including over the phone, by mail, via fax, or through electronic channels. The choice of submission method can affect the speed and efficiency of the PA process, with electronic submissions (ePA) often providing a more streamlined and faster route to obtaining necessary approvals.

We’re Here to Help Streamline the PA Process

Recent findings by the AMA indicate that only about one in four physicians (26%) report that their Electronic Health Record system (EHR) offers Electronic Prior Authorization (ePA) capabilities. If you’re looking to save time, money, and improve the patient experience, ePA integration is the solution you’ve been looking for.

DoseSpot is leading the charge in simplifying the ePA process for healthcare providers by offering:

Benefits of Integrated ePA

DoseSpot offers ePA integrations through CoverMyMeds and Surescripts. These integrated ePA solutions provide a simpler and more streamlined way to review, submit, and track prior auth requests directly within your ePrescribing workflow.

Streamlined Workflows

Complete a medication prior auth for commercial and government sponsored health plans, including Medicare Part D and Medicaid.

Centralized Operations

Providers submit prior auth requests directly to payers, eliminating the need for back and forth phone calls or the risk of exposing protected patient data by using a fax machine.

Faster Responses

Integrated ePA can increase speed to determination much faster than manual submissions. Patients spend less time waiting, and providers spend less time on paperwork.

Intuitive Workflows Keep the Process Moving

DoseSpot providers can initiate the ePA process electronically within the prescription workflow. Pairing perfectly with our Real-Time Prescription benefit integration, where each prescription in real time is flagged if prior authorization is required. One click prompts the provider to enter necessary information, including patient details, medication details, and supporting documentation directly to the insurance provider for prior authorization.

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Alternative Medications are Presented When Prior Authorization is Required

Real-Time Prescription Benefit provides plan-specific information, and makes it clear when prior authorization is required. These two integrations work together. When a medication is flagged, an equivalent therapeutic alternative is also presented, using personalized benefits and formulary-specific information, giving both the provider and patient options. This information is easily readable so the best clinical decision can be made quickly and within the course of the appointment.

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Reduce Gaps In Therapy

With ePA, many steps are automated reducing clinician stress and allowing shortcuts for frequent drugs requiring approval. ePA can accelerate treatment plans and your staff will be able to gain efficiencies with fewer post-visit phone calls, faxes and follow-ups with the pharmacy, payers, and patients. Once complete, patients will feel more at ease and have the medications they need to improve their condition.  

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Electronic Prior Authorization FAQs

Here’s what clients are asking about ePA

Q: What if our patients’ benefits plans aren’t part of the ePA networks?

A: It is possible that you will have a patient whose benefit plan isn’t part of the networks supported by our ePA solution. Instead, easy PDF-based workflows allow you to digitize the needed forms and send them to unconnected payers. 

Q: Are there any security concerns with ePA?

A: Security is a top priority when submitting the ePA . These systems are designed to comply with healthcare data security regulations, such as HIPAA, to ensure the confidentiality and integrity of patient information during the electronic prior authorization process.

Q: How does ePA differ from traditional manual prior authorization?

A: Unlike traditional manual prior authorization, which involves paper forms and faxed documents, ePA automates the process by allowing healthcare providers to electronically submit and receive authorization requests. This reduces administrative burden, accelerates decision-making, and enhances communication between healthcare providers and payers.

With a proactive and more automated approach to ePA, everyone wins.

Q: Can ePA be used for both commercial and government insurance plans?

A: ePA is increasingly being adopted by both commercial and government insurance plans. However, the availability of ePA can vary by payer. Providers should check with each specific insurance plan to confirm their acceptance of ePA requests.

Q: How can healthcare providers track the status of ePA requests?

A: DoseSpot now offers a Pending ePA Report to help providers aggregate their open ePA cases. This transparency allows them to monitor the progress of the authorization process and promptly take necessary actions.

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