Welcome! Optum Rx understands that
your time is valuable and limited,
so we offer digital tools
that create efficiencies
and reduce the time you
spend on your administrative tasks.
We will spend the next few
minutes guiding you through
the use of electronic prior authorization,
e-PA.
But first, let's quickly
review the benefits of prior authorization.
Prior authorization benefits your patients,
your practice,
and the overall healthcare system
in a variety of ways,
managing costs,
controlling medication misuse,
and protecting patient safety to help
ensure the best possible
therapeutic outcomes.
To simplify the PA request process,
Optum Rx offers e-PA.
e-PA transforms
the existing paper PA process into
a real-time exchange of information to
determine insurance coverage
for a prescribed medication.
By submitting e-PA requests,
you can experience benefits such as
faster PA determinations at
no additional cost,
less administrative paperwork,
and minimized therapy
disruption for your patients.
The e-PA process is quick,
simple, and consists of four primary steps.
Step one: Initiate a request.
Submit
your patient's information such as name,
member ID, and requested
medication in an e-PA portal.
Here's a helpful hint: Make sure
the patient's name and date of birth
are spelled and formatted
exactly as shown on
the member's insurance card.
Step two: Optum Rx
reviews the request for coverage.
If applicable, we will send you plan-
specific clinical questions immediately.
Step three: You respond to
clinical questions sent by Optum Rx.
Step four: Optum Rx
reviews and sends you the case
resolution details, such as if the case is
approved or needs
additional information and review.
There are several e-PA portals you can use,
like CoverMyMeds,
SureScripts, PreCheck MyScript,
DrFirst, CenterX
or Allscripts to submit a request.
Let's go through a CoverMyMeds
e-PA request together.
Access the CoverMyMeds portal by
visiting the Optum Rx
prior authorization page.
To begin, create a username and password,
then log into the e-PA portal.
Here is your dashboard.
This is the homepage with
tabs to help locate your existing requests.
New requests that have not yet been
sent to the plan are in the Current tab.
The Sent to Plan tab displays
a list of
your submitted prior authorizations.
The Status indicates a final determination,
such as approved or denied.
Use the Search tab to
find a specific request.
Now, let's submit a new e-PA.
Click on New Request
on the left side of the dashboard.
The medication screen will appear.
Type in the name of the medication and
select
the specific drug option for the request.
Next, complete
the patient's insurance information
by searching insurance plan or PBM name.
Then the Forms section will populate.
Click the Start Request button.
Complete
the patient medication and information form.
Additional questions will generate
depending on your response in each field.
Answer all the required fields.
Here's a few more helpful hints:
Number one: Please
ensure all questions including
diagnosis and tried/failed alternatives
are answered accurately and completely.
Number two: Another way to avoid
e-PA delays is to attach
all necessary chart notes to your submission.
Number three: Finally,
make sure the quantity is based on
unit of measure consistent with
dispensing standards and directions for use.
For example, medications dispensed in
pen form require the number of milliliters,
not the number of pens you need.
The Send To Plan button will turn orange.
Now, submit to Optum Rx.
That's it! You've now initiated an e-PA.
Save time and streamline
your PA submission process by
reducing patient medication disruption,
managing costs, ensuring safety and quality,
and receiving faster PA determinations.
Start using e-PA today.
To learn more, visit
business.optum.com
and search prior authorization.
Bookmark this page for
future quick reference.