E-Prior Authorization

The volume and complexity of utilization management has grown exponentially over the past few years, making this area one of the costliest within the health plan. Health plans and pharmacy benefit managers want a seamless process that allows them to more effectively manage cost. Workflow efficiency and proper management of turnaround time is essential.

Our electronic prior authorization (ePA) program includes an enterprise solution to streamline and manage prior authorizations, electronic prior authorization clinical rules management, distributed workflow, comprehensive document management, and member and physician portal support. This system delivers an end-to-end solution to support all lines of business and automates clinical decision outcomes—eliminating manual and labor-intensive processes in prior authorization management.

Argus offers a self-service solution for members and healthcare providers that allow them to request and check on the status of prior authorizations through a web-based portal. The portal can be deployed through the health plan’s website on their member and provider pages, as appropriate. Members can initiate their request for prior authorization through this portal and, if necessary, the request is sent to the provider for completion. Providers can also initiate and check the status for specific members, complete their request online using any web browser, and attach relevant information such as chart notes and lab reports.

Our e-Prior Authorization (ePA) solution is a standards-based application which can integrate with e‑prescribing applications to bring electronic prior authorization capabilities directly to point-of-care solutions. The ePA service utilizes our automated prior authorization system’s clinical rules engine and is integrated into the prescriber’s electronic medical record (EMR) workflow and based on the ePA transactions as developed within the SCRIPT standard by NCPDP. This functionality enables the prescriber to send a prior authorization request electronically and eliminates the manual fax- and paper-based prior authorization process.

The Argus Automated Prior Authorization system uses the standard electronic format to deliver the appropriate prior authorization criteria directly to the prescriber’s EMR and automatically provides the outcome of the prior authorization request based on the clinical guidelines. The automation with ePA review will allow for accelerated determination and turn around on requests, more cost-effective and integrated workflow for providers, and deliver greater consistency in clinical outcomes while achieving increased prescriber and patient satisfaction.