edgeMED Help Center > Electronic Health Records > eRx
Enhanced Electronic Prior Authorization (EPA).
Electronic Prior Authorization (EPA) has been redesigned to streamline the process of submitting prior authorization requests for your patients' prescriptions. Here's what's new!
Set priority for urgent requests
Prior authorization requests are automatically initiated for medications that may require it
Question sets can be accessed and completed from the prescription preview screen
Answers are pre-populated if the information is already in the patient's chart
Attach documents to the question set
Prescriptions are held until the EPA is approved to mitigate confusion and prevent delays at the pharmacy
The EPA worklist is combined with specialty enrollment tasks on the prescriber dashboard to improve visibility and task management
Third-party processing and built-in URL links allow more prior authorizations to be completed electronically
Payers can respond to requests as Partially Denied, which indicates that the prior authorization has been approved by the payer but may be limited by pharmacy type, quantity, days supply, number of cycles, and/or number of refills
Select a topic below or scroll through the page for all content.
Initiate the EPA Process
A combination of the patient's formulary and real-time prescription benefit (RTPB) information is used to automatically initiate EPA for medications that require it. This is completed behind the scenes after a pharmacy has been selected for the prescription and that pharmacy checks to see if the PBM/payer requires prior authorization for the prescribed medication.
If prior authorization is required, this will be indicated on the prescription preview screen.
Answer the Question Set
Click Start to open the question set from the PBM or health plan.
Click Complete Prior Auth Criteria.
Click Start.
Complete the questions returned by the payer.
If any of the information requested is already available within the patient chart, it will be pre-populated on the question set.
If the PBM or health plan does not support electronic prior authorizations, a URL will be provided to complete the prior authorization request outside of the software.
Note: Prescriptions will not be held when the prior authorization is completed outside of the software.
Click Send closed BY response.
Click View PA Form. The form will open in a new tab to be completed outside of the software.
Rx Tasks
After completing the question set, close the popup to return to the prescription preview screen, then click Send.
You will be directed to the Rx Tasks tab of the prescriber dashboard where prescriptions awaiting prior authorization are held. Any prescriptions that did not require prior authorization will be sent directly to the pharmacy and will show up within the Recent tab on the prescriber dashboard as usual.
EPA Status
As you can see on the below screen, the status of the prior authorization can be found on the right. Additional details about the request status can always be accessed by clicking the task name in the first column.
Not started
The question set has not been completed. Click Complete to answer the questions and submit the request.
In progress
The PBM or health plan is reviewing the request. No changes can be made to the prescription at this time.
Approved
The prior authorization request has been approved. Non-controlled prescriptions will be sent automatically to the pharmacy the morning after the EPA was approved. Click Send Rx to send the prescription sooner.
EPCS prescriptions will remain on the task list since the OTP must be entered before the prescription is sent to the pharmacy. Click Send Rx to send EPCS prescriptions to the pharmacy.
Denied
The prior authorization request has been denied so the prescription has not been sent to the pharmacy. A new prescription for a different medication can be generated, or click Send Anyway to transmit the prescription without prior authorization.
Note: Sending a prescription without prior authorization may result in an additional cost for the patient.
Partially denied
The prior authorization request has been approved by the payer, but with some limitations. Limitations may include pharmacy type, quantity, days supply, number of cycles, and/or number of refills. Click Edit Rx to make the appropriate changes to the prescription and send it to the pharmacy.
Closed
Requests can be closed without approval for multiple reasons including a duplicate request, questions answered after the deadline for reply, and/or other reasons determined by the PBM or health plan. Click on the task name to see more detail about a closed request.
If the PBM or health plan does not support electronic prior authorization but offers a web-based PA form, the URL to access the form will be available by clicking on the task name. Automatic approval/denial will not be received in these cases, and the status of the request will remain closed.
Prior Authorization Renewal Requests
When a prior authorization is expiring, the PBM or health plan may send an unsolicited question set to prevent a lapse in medication. These requests will be displayed in the Rx Tasks tab with a status of Not Started.
Click Complete to provide the requested information and submit the request.
Cancelling the EPA
An electronic prior authorization request can be canceled at any time by clicking on the task name. When an EPA is canceled, the prescription will move to the Pending tab so that it can be Voided to remove or Approved to send it to the pharmacy.
