Version 14.19
ePA Tasks
For ePA records with a Status of Action Required, a task is required to progress the PA. There are two response types:
- Open Response: The PBM has responded that a PA is required for the selected drug based on patient-specific circumstances. The action required at this point is to complete the payer’s Question Set. When a PBM responds to an initiated PA or if a PBM needs additional questions answered in response to an appeal or insufficient initial data, the PBM responds with an Open ePA message which contains a Question Set.
- Acknowledgement Response: Responses of Approved, Denied, and Closed require you to acknowledge the response to indicate the outcome was accepted. The acknowledgement is required to finalize the PA. Acknowledging the response electronically eliminates any possibility for a user to appeal the response electronically, although a manual appeal is still possible.
Users also have the ability to appeal a PA that has been denied.
Open Response
By clicking on the record, CompletEPA immediately launches the task and displays a Question Set from the payer that the user begins by clicking Start.
Question Sets are intended to have a built-in logic that prevents users from being presented with irrelevant questions. However, content and complexity of the question set logic varies by PBM or payer. The progress bar indicates current progress towards completing the Question Set.
Navigating to the next question automatically saves progress on previously answered questions. Progress is not automatically saved by clicking on ‘Go to Process’ or ‘Return to Worklist’. Users must click the Next button to manually save progress on the current question.
Once a task is opened, it immediately becomes locked by the user that opened it.
Others are unable to open the task until the initial user manually chooses to release or exit the task (or times out after one hour of inactivity) . Returning to the Worklist will release the question set. This does not submit the question set to the PBM or payer but allows the user to finish it at a later point or allows another user to finish responding.
There are different options for answering a question based on the question type. Data-type validation on responses is performed before allowing them to be saved or submitted to the PBM. This means that a single select question will not allow users to submit multiple selections and a number type question will be limited to numerical values. However, the validity of a response is not checked.
Question types:
- Single-select: Indicates the answer to the question is to be selected from a set of choices. Radio buttons are displayed to indicate that a single response may be selected.
- Multi-select: Indicates the answer to the question is to be selected from a set of choices. Check boxes are displayed to indicate that multiple responses may be selected.
- Date: Indicates the answer to the question is a date.
- Numeric: Indicates the answer to the question is numeric. Conditional logic is used to determine the next question based on an exact value provided or upper/lower bounds.
- Free Text: Indicates the answer to the question is free text.
- Comments: PBMs and Payers can indicate if free text comments are allowed or required for specific responses to questions.
After the question set is completed, a summary is presented.
The user should carefully review all responses to ensure accuracy and prevent delay in processing. If a response needs to be changed, the user may click the back button to navigate to the most recently saved question, select the specific response for a particular question and go back and make changes to it, or select Start Over to begin the Question Set from the beginning.
Once responses have been verified, select the Submit button to send the completed Question Set to the PBM/payer.
ePA Responses
When the response from the PBM/payer is Approved, Denied, or Closed, the prescriber must submit an acknowledgement.
A Closed response (when a PA is not needed) or an Approved PA only require the prescriber to click the Acknowledge button.
However, a Denied response provides two options: Acknowledge or Appeal.
An appealed response may result in an additional Question Set and requires an additional response from the PBM/payer with another acknowledgement before the PA reaches its final state.
To view details of a task, click Go to Process.
Clicking the Go to Process button provides a history of that particular record.
Click the Action Required link in order to return to the task.
Responses that Contain Attachments
If the response from the PBM/payer contains an attachment, CompletEPA displays an attachment tab.
Click the Accept and Download button to view the .zip file containing the attachment. Ensure that you follow proper security protocols when viewing Protected Health Information (PHI).
PDF Form Functionality
If CompletEPA is unable to find an electronic route for an ePA, a search for an online form can be automatically initiated through the use of electronic forms provider PDR. Using the information submitted in the original request, PDR is able to search their online library of PA forms and return a link to a user that allows them to enter the required details. The ePA process within the EHR is completed once the link is returned and the task is acknowledged. At this point, the user receives no further communication regarding the ePA within OP.
Version 14.10
ePA Tasks
For a video on ePA Tasks, click here.
For ePA records with a Status of Action Required, a task is required to progress the PA. There are two response types:
- Open Response: The PBM has responded that a PA is required for the selected drug based on patient-specific circumstances. The action required at this point is to complete the payer’s Question Set. When a PBM responds to an initiated PA or if a PBM needs additional questions answered in response to an appeal or insufficient initial data, the PBM responds with an Open ePA message which contains a Question Set.
- Acknowledgement Response: Responses of Approved, Denied, and Closed require you to acknowledge the response to indicate the outcome was accepted. The acknowledgement is required to finalize the PA. Acknowledging the response electronically eliminates any possibility for a user to appeal the response electronically, although a manual appeal is still possible.
Users also have the ability to appeal a PA that has been denied.
Open Response
By clicking on the record, CompletEPA immediately launches the task and displays a Question Set from the payer that the user begins by clicking Start.
Question Sets are intended to have a built-in logic that prevents users from being presented with irrelevant questions. However, content and complexity of the question set logic varies by PBM or payer. The progress bar indicates current progress towards completing the Question Set.
Navigating to the next question automatically saves progress on previously answered questions. Progress is not automatically saved by clicking on ‘Go to Process’ or ‘Return to Worklist’. Users must click the Next button to manually save progress on the current question.
Once a task is opened, it immediately becomes locked by the user that opened it.
Others are unable to open the task until the initial user manually chooses to release or exit the task (or times out after one hour of inactivity) . Returning to the Worklist will release the question set. This does not submit the question set to the PBM or payer but allows the user to finish it at a later point or allows another user to finish responding.
There are different options for answering a question based on the question type. Data-type validation on responses is performed before allowing them to be saved or submitted to the PBM. This means that a single select question will not allow users to submit multiple selections and a number type question will be limited to numerical values. However, the validity of a response is not checked.
Question types:
- Single-select: Indicates the answer to the question is to be selected from a set of choices. Radio buttons are displayed to indicate that a single response may be selected.
- Multi-select: Indicates the answer to the question is to be selected from a set of choices. Check boxes are displayed to indicate that multiple responses may be selected.
- Date: Indicates the answer to the question is a date.
- Numeric: Indicates the answer to the question is numeric. Conditional logic is used to determine the next question based on an exact value provided or upper/lower bounds.
- Free Text: Indicates the answer to the question is free text.
- Comments: PBMs and Payers can indicate if free text comments are allowed or required for specific responses to questions.
After the question set is completed, a summary is presented.
The user should carefully review all responses to ensure accuracy and prevent delay in processing. If a response needs to be changed, the user may click the back button to navigate to the most recently saved question, select the specific response for a particular question and go back and make changes to it, or select Start Over to begin the Question Set from the beginning.
Once responses have been verified, select the Submit button to send the completed Question Set to the PBM/payer.
ePA Responses
When the response from the PBM/payer is Approved, Denied, or Closed, the prescriber must submit an acknowledgement.
A Closed response (when a PA is not needed) or an Approved PA only require the prescriber to click the Acknowledge button.
However, a Denied response provides two options: Acknowledge or Appeal.
An appealed response may result in an additional Question Set and requires an additional response from the PBM/payer with another acknowledgement before the PA reaches its final state.
To view details of a task, click Go to Process.
Clicking the Go to Process button provides a history of that particular record.
Click the Action Required link in order to return to the task.
Responses that Contain Attachments
If the response from the PBM/payer contains an attachment, CompletEPA displays an attachment tab.
Click the Accept and Download button to view the .zip file containing the attachment. Ensure that you follow proper security protocols when viewing Protected Health Information (PHI).
PDF Form Functionality
If CompletEPA is unable to find an electronic route for an ePA, a search for an online form can be automatically initiated through the use of electronic forms provider PDR. Using the information submitted in the original request, PDR is able to search their online library of PA forms and return a link to a user that allows them to enter the required details. The ePA process within the EHR is completed once the link is returned and the task is acknowledged. At this point, the user receives no further communication regarding the ePA within OP.
