7 Strategies to Improve Prior Authorization Management from Anywhere

While there have been prior authorization (PA) policy changes^[1]Prior Authorization (PA) Policy Changes Related to COVID-19, AMA, 2020 in recent months, many providers are still completing necessary PA requests — a process complicated by the impact of COVID-19. Without office infrastructure, providers and staff face challenges to the way they work that they’ve never encountered before: no fax machine access, limited personal interactions on phone calls and video chats and a wide range of at-home technology situations.

The good news: There are ways to improve and adapt, even if you’re helping patients from afar. Read on for seven approaches to improving the PA request process — no matter where you're working.

1) Assess your access

While working remotely may feel like you’re stranded on an island, there may be a hidden oasis within the tools you have. If your EHR/EMR is equipped with an integrated PA solution, simply gaining secure, remote access to your records can nearly automate the PA process. Auto-starting and auto-populating PA requests with stored information and communicating in real-time via electronic connections can help smooth the process. Also, consider taking inventory of other technology at your disposal: virtual desktop infrastructure, electronic fax solutions and various types of electronic benefit verification can serve as building blocks for a solid remote office. If you don’t have an integrated solution, covermymeds.com is available for PA request management from anywhere.

2) Verify your prescribers

Verifying your prescribers allows you to automatically receive all PA requests started by pharmacies in your CoverMyMeds account as well as email notifications. Do this by clicking “Verify Prescribers” at the top of your account dashboard and following the instructions. The process includes verifying via fax, which leads to the next strategy…

3) Assign a fax gofer

While many healthcare systems have transitioned to electronic methods, nearly half of all PA volume is still submitted through phone and fax.^[2]Payer data collected by CoverMyMeds, 2018 If you don’t have your office’s faxes electronically delivered, designating one employee to go into the office to retrieve faxes and distribute among the team may be a good solution. This limits social contact and allows workflows to move forward with a solid communication strategy in place.

4) Develop a communications strategy

While running down the hall for a quick signature or interrupting a coworker may have been standard practice prior to COVID-19, these habits are not only impossible right now — they’re not efficient, either. Embracing virtual connectivity allows teams to manage notifications, stay abreast of the concerns du jour and efficiently share both talent and knowledge resources. In fact, 81 percent of employees using peer collaboration apps said their productivity improved.^[3]UC Today, “Team Collaboration Software Statistics,” April 19, 2019 Clear job roles and responsibilities surrounding PA requests will help improve workflows in addition to well-formed communications.

5) Adopt a process specific to telehealth

Ready or not, telehealth may be the new normal. According to one survey, nearly half of physicians are now using telehealth, up from 18 percent in 2018.^[4]Nearly half of physicians using telehealth, up from just 18% in 2018, Healthcare IT News, 2020 Just as the visit itself will look different for physicians and patients, so will the documentation and workflow that follow. Instead of trying to jam a square peg into a round hole, it may be best to create a separate set of directives for telehealth appointments.

6) Remember key functionalities

Necessity is the mother of invention, and healthcare office operations may need to get inventive to solve medication access challenges. Here are a few tips to remember about the CoverMyMeds ePA workflow: • PA requests started at the pharmacy can be auto-shared • Multiple accounts can be linked with group functionality • Even at covermymeds.com, existing users can share functionality under the same NPI

7) Reach out – we’re still here to help

The CoverMyMeds team is committed to helping the PA process go smoothly, no matter where you’re helping patients. As you may expect, we’ve seen an increase in inbound support calls and chats relative to last year.^[5]Medication Access During Uncertain Times—Improving Provider Workflows to Help Patients in Need, Drug Channels, 2020 On average, our team responds to most inbound messages within 20 seconds.^[6]CoverMyMeds data on file We also regularly offer training webinars where you can learn how easy it is to use CoverMyMeds for PA requests and have the opportunity to ask our experts questions.

We’re here to support you as we navigate the new face of healthcare together.