Address a Prescription with a Prior Authorization Request

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The Patient Tab > Electronic Prescribing and Medication Management > Using Care360 ePrescribing > Address a Prescription with a Prior Authorization Request

Address a Prescription with a Prior Authorization Request

1 On the Message Center tab, click Prescriptions > Action Items.

Tip: You can also access the Action Items list by clicking the Action Items link from the Quick View page, or by clicking Prescriptions > Action Items from a patient’s summary.

2 To view activity for a specific provider within the organization, click a provider in the Provider Filter list.

3 In either the Prior Authorizations in Progress or Pending Approvals list, click a prescription with an in progress prior authorization.

Notes:

• Prescriptions (with prior authorization requests) that are pending approval are listed in the Pending Approvals section; prescriptions that have been approved, or are neither approved nor pending approval, are listed in the Prior Authorizations in Progress section.

• Electronic prior authorization notifications are available only for Care360 EHR or ePrescribing organizations that have Electronic Prior Authorization.

4 While viewing the prescription details, do any of the following:

• Review the request status. Review the message in the yellow banner that is located beneath the medication information to view the status of the prior authorization request as it is processed, and if available, links for items needing action.

• Access questions. If available, click Answer Questions next to the message indicating the prior authorization is in progress to view and answer a series of questions regarding the patient and the prescribed medication. Once the questions have been answered, the submission of the prior authorization request is complete.

If a prior authorization is approved, no further action is required on the prior authorization request. The prescription is handled as follows:

Prescription Status	Details
Pending Approval	A pending prescription with an approved prior authorization request remains in the Pending Approvals section and on the Rx pad until the prescription is approved. For more information about addressing a prescription pending approval, see Address a Prescription Pending Approval.
Approved	An approved prescription is immediately removed from the Action Items - Prior Authorizations in Progress list upon prior authorization approval. If the prescription in the Prior Authorizations in Progress list is being delivered to the pharmacy electronically, it is also immediately removed from the Rx pad and sent to the pharmacy, and the medication is added to the patient’s list of active medications.
Neither Approved nor Pending Approval	If a prescription is neither approved or pending approval, it is immediately removed from the Action Items - Prior Authorizations in Progress list upon prior authorization approval, but remains on the Rx pad until the prescription is approved. For more information about approving prescriptions, see Submit the Prescription.

• Manage a denied request. If a prior authorization request is denied for a prescription, you can do the following to manage the request:

• Prescriptions pending approval or neither approved nor pending. For pending prescriptions in the Pending Approvals list, or prescriptions in the Action Items - Prior Authorizations in Progress list which are neither approved nor pending approval, you can manage a denied prior authorization request as follows:

Electronic Appeal Available?	Request Management Options
No	• View the denial details. To view additional details about the denied prior authorization request, such as why the request was denied, click View Denial. • Delete the prescription. Click Edit to return to the Rx pad, and then click next to the medication. The associated prior authorization request is automatically canceled. • Send the prescription anyway. To send the prescription without the prior authorization approval, click Edit to return to the Rx pad and approve the prescription as usual. For more information about approving prescriptions, see Submit the Prescription.
Yes	• Appeal the denial. To initiate an electronic appeal for the denied prior authorization request, click Appeal Denial. From the request details page click the action required link, and then the appeal button. If Answer Questions appears, click the link to answer the questions and complete the request. Status messages appear to notify you of the appeal’s progress and outcome. If the appeal is approved, no further action is required and you can continue with approving the prescription as usual from the Rx pad; if denied, you can appeal again, or click Edit to return to the Rx pad and delete the prescription or send it without the prior authorization approval. • Delete the prescription. Click Edit to return to the Rx pad, and then click next to the medication. The associated prior authorization request is automatically canceled. • Send the prescription anyway. To send the prescription without the prior authorization approval, click Edit to return to the Rx pad and approve the prescription as usual. For more information about approving prescriptions, see Submit the Prescription.

Electronic Appeal Available?

Request Management Options

• View the denial details. To view additional details about the denied prior authorization request, such as why the request was denied, click View Denial.

• Delete the prescription. Click Edit to return to the Rx pad, and then click next to the medication. The associated prior authorization request is automatically canceled.

• Send the prescription anyway. To send the prescription without the prior authorization approval, click Edit to return to the Rx pad and approve the prescription as usual. For more information about approving prescriptions, see Submit the Prescription.

Yes

• Appeal the denial. To initiate an electronic appeal for the denied prior authorization request, click Appeal Denial. From the request details page click the action required link, and then the appeal button. If Answer Questions appears, click the link to answer the questions and complete the request. Status messages appear to notify you of the appeal’s progress and outcome.

If the appeal is approved, no further action is required and you can continue with approving the prescription as usual from the Rx pad; if denied, you can appeal again, or click Edit to return to the Rx pad and delete the prescription or send it without the prior authorization approval.

• Delete the prescription. Click Edit to return to the Rx pad, and then click next to the medication. The associated prior authorization request is automatically canceled.

• Approved retail pharmacy prescriptions. If an approved prescription in the Action Items - Prior Authorizations in Progress list is being delivered to a pharmacy electronically, you must click the actions link (View Denial or Appeal Denial) in the yellow banner to return to the Rx pad and address the denied prior authorization request. For more information about addressing prior authorization requests from the Rx pad, see step 3 (for prescriptions pending approval or not pending/approved) or step 7 (for approved prescriptions) of Submit the Prescription.

• Approved Sample/Handwritten prescriptions. Approved prescriptions for Sample/Handwritten delivery are immediately removed from the Rx pad upon prescription approval and the medication is immediately added to the patient’s Medications (Active) list. Denied prior authorization requests for approved Sample/Handwritten prescriptions can only be managed from the Action Items - Prior Authorizations in Progress list as follows:

Electronic Appeal Available?	Request Management Options
No	• View denial details. To view additional details about the denied prior authorization request, click View Denial. To remove the prescription from the Action Items - Prior Authorizations in Progress list, you must acknowledge the denial from the request details by clicking the action required link, and then the acknowledge button.
Yes	• Appeal the denial. To initiate an electronic appeal for the denied prior authorization request, click Appeal Denial. From the request details page click the action required link, and then the appeal button. If Answer Questions appears, click the link to answer the questions and complete the request. Status messages appear to notify you of the appeal’s progress and outcome. If the appeal is approved, the prescription is immediately removed from the Action Items - Prior Authorizations in Progress list; if denied, you can appeal again or acknowledge the denial.

Electronic Appeal Available?

Request Management Options

• View denial details. To view additional details about the denied prior authorization request, click View Denial. To remove the prescription from the Action Items - Prior Authorizations in Progress list, you must acknowledge the denial from the request details by clicking the action required link, and then the acknowledge button.

Yes

If the appeal is approved, the prescription is immediately removed from the Action Items - Prior Authorizations in Progress list; if denied, you can appeal again or acknowledge the denial.

Note: In addition to an approved or denied status, you may also receive notification that a prior authorization request has been closed, deferred, or canceled, or that it has resulted in an error. As with a denied prior authorization, you can click the associated link to view more details about the request status, or to take action based on the request status.