E-Rx: Electronic Prior Authorization (ePA)
Automatically prompts electronic prior authorization when a prescribed medication requires payer approval, checking the client's SureScripts-sourced coverage details and letting the provider submit the request directly to the payer without leaving DoseSpot. Attempting to send a prescription without completing a required PA surfaces a warning before the order can be finalized. Powered by DoseSpot's expanded ePA network, including CoverMyMeds.
Built by Core Engineering
The problem it solves
Prior authorization traditionally requires manual paperwork and phone calls between clinical staff and the payer, delaying when a client can actually get their prescription filled. Electronic Prior Authorization solves this by checking coverage and submitting the PA request electronically, integrated into the same workflow where the prescription was written.
What's included
- Automatic prior authorization requirement check against SureScripts Coverage Details
- In-workflow ePA submission from a pending medication's Actions dropdown
- Warning before sending a prescription that requires PA but hasn't completed it
- Active Prior Authorization Requests tracking for in-progress submissions
- DoseSpot's expanded ePA network, including CoverMyMeds
How it works
Once a medication is saved as a pending prescription, if it requires prior authorization, the provider selects Start Prior Authorization from the medication's Actions dropdown; this is tied to the client's Coverage Details, populated automatically from SureScripts when available. Selecting EPA Request sends the PA initiation request directly to the payer, moving the medication from Pending Medications to Active Prior Authorization Requests, where its progress can be tracked. If a provider attempts to send a prescription without completing a required PA, a warning appears in the Actions Before Sending step before the order can be finalized. ePA works only for medications with pre-populated formulary information in DoseSpot.
Electronic Prior Authorization (ePA) automatically prompts a prior authorization request when a prescribed medication requires payer approval, using the client's SureScripts-sourced Coverage Details to determine if PA is needed and letting the provider submit the request electronically without leaving the prescribing flow. It's built to replace the manual, often staff-driven prior authorization process with a faster, in-workflow submission that returns a decision from the payer more quickly. If a provider attempts to send a prescription that requires PA without completing it first, Healthie surfaces a warning in the Actions Before Sending step. ePA is available for medications with pre-populated formulary information in DoseSpot, and runs on DoseSpot's expanded ePA network, which includes CoverMyMeds.