Prior Authorization without Key
Prior Authorization without Key
|
Overview: Creating an electronic prior authorization in cover my meds (CMM) |
Audience: Front office support and prescribers |
Review: Prior authorizations are necessary when insurance does not normally cover a medication. We will submit reasoning or an ePA as to why the patient needs the medication to request insurance to cover it. Practice assistants are required to support the provider and fill in the ePA until they can no longer proceed.
Where
to find your PA request:
1. In the clinical inbox find the “Orders/Rx/Auths” bucket.
2. Select the prior authorization request which is labeled “Prescription – Prior Authorization Request.”Generating the ePA in CMM:
1. Open CMM in another screen and log in
2.
From the CMM
dashboard select “”
3. Find the medication that’s listed on the PA request ensuring to select the right dose.
4. Enter the patient information using the patient account > select “Continue”
5.
Input
the insurance information. If the patient has an insurance card on file use the
BIN, Rx, or PCN listed on the patient’s insurance card. If the card does not
hold this information search the plan name. Ensure to click on the
correct form > select “Start request.”
6. Fill in all the “Required” fields on the form using the patients chart in Athena to indetify the required information. If the option to “confirm eligibility”exists, Confirm this first to proceed. If eleigibility cannot be found go back and select a new form or call in the prior authorization using the number listed in the notes/message section of the prior authorization request or the member services line on the patients insurance card.
7. Once the required fields are completed select “Send to Plan”
8.
A question set may become available immediately,
follow the prompt on the screen. If a question set becomes available answer the
questions to the best ability
using the “Visits” and “Meds” tab in the chart to find the answers. Select
“Send to Plan” once questions are completed . IF unable to proceed
because answer is unknown, send the KEY (Listed at the top of the ePA) to the
provider to complete the ePA.
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