Implementing ePrior Authorization: A Step-By-Step Guide

A survey by the American Medical Association (AMA) indicated that 92% of clinicians report care delays because of prescriptions requiring prior authorization. Another 92% indicate prior authorization can have a negative impact on patient clinical outcomes. Practice Fusion, with Surescripts, encourages clinicians to implement electronic prior authorization (ePA) in their workflow to help combat these staggering numbers. Electronic submission for prior authorizations can significantly reduce wait times for clinicians and ultimately patients. We recently outlined reasons why utilizing ePA could save practices time, improve speed to therapy, as well as improve medication adherence.

When a clinician orders a medication in the Practice Fusion EHR that requires prior authorization based on the patient’s Pharmacy Benefit Manager (PBM) or Health Plan, steps can be taken to electronically generate and submit the prior authorization while the patient is still being seen. This action can help eliminate unnecessary phone calls and faxes to and from PBMs and pharmacies. Formulary files, which help prescribers make prescribing decisions, are provided to prescribers within the EHR by PBMs and insurers. These files provide prescription coverage status, alternative medications, copay details, and coverage factors.1 Another way to improve workflow and reduce medication abandonment is to follow proper steps for cancelling a prescription. If an electronic prior authorization is generated for a prescription and changes are made by the prescriber after submission, this could lead to an open prior authorization. Cancelling these open prior authorizations will reduce open actions within the patient chart and help prevent medication errors.

Practice Fusion EHR users can refer to this webinar, hosted with Surescripts, for a step-by-step guide on generating, submitting, and cancelling a prior authorization within the EHR. Together with Surescripts, Practice Fusion is working to improve practice workflow and reduce administrative burden so you can get back to what matters most – your patients.

  1. Surescripts ePrior Authorization Tip Sheet