electronic prior authorization

10 Things Payers Need to Know About Electronic Prior Authorization

By Jocelyn Keegan, Payer Practice Lead Payer interest is growing in electronic prior authorization (ePA). Initially, in many organizations, automation largely replicated the paper process requiring duplicate entry of information. …

Diving Deeper into CMS’ Proposed Rule on Electronic Prior Authorization for Medicare Part D Drugs

By Jocelyn Keegan, Payer Practice Lead, and Ken Kleinberg, Innovative Technologies Practice Lead The Center for Medicare and Medicaid Services (CMS) recently announced a proposed rule that would require use …

Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278

By  Ken Kleinberg, Practice Lead, Innovative Technologies CAQH’s (Council for Affordable Quality Healthcare) recently released their new Phase V CORE Operating Rules for prior authorization (PA) that improve on specificity …

Electronic Prior Authorization On the Radar to Improve Medication Access

by Tony Schueth, CEO & Managing Partner A growing number of medications require prior authorization (PA) before they can be dispensed. This is a concern among providers, who are very …

Feds’ Year-End Guidance Will Affect Electronic Prescribing and EHRs

By Tony Schueth, CEO and Managing Partner The world of health IT was buzzing this week in the wake of a massive rule drop by the Office of the National …

Beyond the AI Hype: Practical Applications to Augment Medication Management Decisions (Part 2)

By Michael Solomon, Ph.D., MBA This is the second of a three-part series on AI applications to support prescription drug prescribing and therapy Amidst the uncertainty of healthcare policy and …

Opioid Law Creates Mandates for ePrescribing under Medicare Part D

By Tony Schueth, CEO and Managing Partner Changes are coming to electronic prescribing (ePrescribing) under Medicare Part D, as part of sweeping new legislation concerning the opioid epidemic that was …

Opioid Management and Electronic Prior Authorization Among Key State and Federal Legislative Initiatives

By Keith Fisher, R.Ph. Co-lead of the Regulatory Resource Center It’s been a busy legislative spring in the world of electronic prescribing (ePrescribing) at both the federal and state levels. …

Electronic Prior Authorization Being Brought into Pharmacists’ Workflow

By Jocelyn Keegan, Senior Consultant With recent legislative changes and maturity in the industry, pharmacists will soon be enabled to electronically initiate and handle pre-approval—or prior authorization (PA) — directly …

How Pharmaceutical Companies Could be Affected by the AMA’s Prior Authorization and Utilization Management Reform Proposal

Prior authorization (PA) for medications, devices and services is viewed as a valuable utilization management tool by payers but is a long-standing pain point for providers, pharmacists and the pharmaceutical …