ePA Process Step by Step
This article describes an expected workflow for the default configuration of the CoverMyMeds ePA process. Given the ePA process is a coordinated effort between the ePA Task assignee/prescriber, and Payer/PBM multiple variations to workflow or process can exist.
- A user with appropriate settings enabled prescribes medication and the Benefit Check is run automatically at the time of print/send/queue. If the RxBC response is "PA Required" there will be an opportunity for the user to assign an ePA task to a user or user group. Utilizing the company and user settings for "EPA Processor", this value can default to a configured user/group.
- Once, the "Print/Queue/Send as Prescribed" button is selected, the ePA task is created and is available to the assignee in the My Task List > CoverMyMeds ePA > My Assigned queue in the status of Initiated
- The ePA processor will work their My Assigned list. The first status change will be from Initiated -> Follow Up this will mean there is a question set being presented that needs to be completed in order for the Payer/PBM to adjudicate the request.
Complete the question set and submit the answers. This will change that status from Follow Up -> Submitted- Some cases may require attachments to be included with the ePA submission. In the header of the ePA task there is an icon that will pull up a screen allowing a user to attach either a SOAP Note, Order Result, or eDocument.
- Some cases may require attachments to be included with the ePA submission. In the header of the ePA task there is an icon that will pull up a screen allowing a user to attach either a SOAP Note, Order Result, or eDocument.
- When the payer responds to the submission the task will either contain the adjudication and may be returned as Denied or Approved. The payer may also ask additional questions after the initial set, in this case, the ePA processor would work to submit the question set again. Otherwise, a user will complete the necessary steps to complete the PA such as calling the patient or communicating with the prescriber to determine an alternative treatment plan. In either case, the user will need to mark any "Pending" ePA as Complete in order to remove it from the My Assigned list and into the Completed category.
