Maine Community Health Options Prior Authorization Form

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Maine Community Health Options Prior Authorization Form

Maine Community Health Options Prior Authorization Form

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Learn more about health options. Compare plans and benefits, learn how to choose the plan that’s right for you. The benefits are widely recognized: When a prior authorization (PA) prescription is transmitted electronically, patients receive their medication faster and are more likely to adhere to prescribed care files.1, 2019

This is why electronic prior authorization (ePA) has been implemented throughout the healthcare network: today, nearly 100 percent of pharmacies, payers and electronic health records (EHR) have an ePA solution.

Despite the rapid integration of ePA over the last decade, almost half of the authority’s volume is still sent through traditional channels such as telephone and fax. 2 Payer data collected until 2018.

Maine Community Health Options Prior Authorization Form

In the Sixth National Adoption of Electronic Prior Authorization Report, we focus on provider adoption of ePA*—examining the impact on patient access to medications and how ePA optimization can lead to greater adoption.

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Ongoing education about the benefits of ePA can encourage provider adoption. The health network must continue to update the current processes in order to limit the use of outdated authority channels and promote the proliferation of providers. Emphasis should also shift toward the benefits of prescription decision support solutions (PDS) that include ePA, making potential authorization requests a more organic part of prescribers’ workflow.

As healthcare systems continue to grow rapidly, ensuring easy access to an ePA solution not only helps reduce the burden on providers, but can also benefit patient health. Data show that the adoption of ePA through EHR systems and health systems correlates with reduced time to treatment and increased patient medication adherence. 1 files, 2019

We define a “provider” as a prescriber and all members of his or her care team, including nurses, physician assistants, office managers, and prior authorization specialists.

Understanding the factors influencing the adoption of ePA providers is critical to the success of the solution in the industry, as more than half of all PA volume still comes by phone and fax.

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Requests for early approval can be submitted when the drug is given by prescription (possible) or after the claim is rejected (retroactive), usually from the pharmacy.

A recent case study showed that patients receive their medications an average of 13.2 days earlier when requests are sent prospectively versus retrospectively.3 Data, 2018 However, retrospective ePA rates are still higher than prospective ePA rates, suggesting that providers may not be aware in real time. and cost savings through potential ePA.

In a recent survey of 400 providers, 60 percent of respondents reported that their practice makes PA requests after the pharmacy has notified them that PA requests are needed. 20 percent reported that they completed applications after the patient notified them of a requirement for an authorization, while only 17 percent reported that they began treatment with an authorization at the time of prescription. 4 Provider Survey, 2019

Maine Community Health Options Prior Authorization Form

The upcoming ePA could mean that patients will receive their medication 13 days faster. In a recent study, however, only 17% of providers reported that they initiated an authorization request when prescribing. 4 Provider Survey, 2019

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One reason why providers avoid initiating requests from the Authority at the time of prescription? They do not fully trust the plan formula information provided in the EHR. 60 percent said they only sometimes trust their EHR data, while 19 percent said they rarely or never trust that data.4 Provider Survey, 2019

Advanced real-time benefit testing (RTBC) technology can provide providers with highly accurate patient data at the time of prescription, providing visibility into the prescriber’s PA requirements. RTBC and ePA are already used as an effective combination to accelerate treatment.

The RTBC solution may not cause the provider to make a PA request in the future. In fact, with this information, the provider may decide to prescribe an alternative drug that does not require PA or help the patient find a cash alternative. However, a better understanding of the options at the prescription stage can lead to more consistent and safer PA processes.

Despite evidence that using an electronic solution results in faster PA determinations, 49 percent of providers reported occasionally using non-electronic methods (

Prior Authorization And Notification

Although 62 percent of electronically submitted PA applications receive a decision within two hours, and 43 percent receive an automated decision, 3 File, 2018, 33 percent of providers still choose phone or fax over ePA to complete urgent applications. 4 suppliers, 2019

Twenty-eight percent of providers surveyed said they revert to non-electronic methods when handling complex prescription situations, 20 percent automatically use non-electronic methods when they are unsure if ePA is an option for a particular plan, and 19 percent chose manual submission. for special medicines. 4. Survey of service providers, 2019

Due to the huge volume of retroactive authorization requests, the pharmacist is often responsible for answering the patient’s questions and initiating the authorization request.

Maine Community Health Options Prior Authorization Form

The long-term goal of the industry should be to empower providers to run future PA requests using the RTBC tool, but the short-term solution is to use an automated PA pharmacy solution.

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This technology automatically initiates a PA request when a need is anticipated based on historical data, notifies the provider of a deferral option and resolution, and reduces the likelihood of a prescription being denied.

Service providers report that they spend a lot of time on administrative processes such as PA. In addition to broader education about the benefits of ePA, optimizing the solution is critical to increasing vendor adoption.

Although PA is designed to control costs, reduce unnecessary prescription drug use, and optimize patient care outcomes, it can create a significant administrative burden for providers. In fact, 86 percent of physicians believe that the burden of the PA is high or very high, while 88 percent believe that the burden of the PA has increased in the last five years. 5 American Medical Association Advance Licensing Survey, 2018

The providers spend an average of 14.9 hours – about two business days – on their workload at the Authority. 5 American Medical Association Advance Licensing Survey, 2018

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In the survey, 1,453 service providers described the challenges facing the PA process and the benefits of ePA. 6 Provider Survey, 2018 Despite these benefits, more than half of all PA volume is still conducted through phone and fax channels.

This time-consuming manual process has ramifications beyond the doctor’s office, affecting pharmacies, HMOs and ultimately the patient.

According to the American Medical Association’s latest study on the subject, the burnout rate of service providers dropped below 50% for the first time since 2011. In a survey of more than 5,000 physicians, 43.9 percent reported at least one symptom of burnout (emotional exhaustion, feelings of cynicism and disengagement from work and a poor sense of personal accomplishment), compared to nearly 55 percent in 2014.7 Burnout and satisfaction with a combination of physicians and the US in the working population between 2011 and 2017, Mayo Clinic

Maine Community Health Options Prior Authorization Form

26 percent of the survey respondents reported that they saw a reduction in their face-to-face time with patients as a result of administrative work such as the authority. 16 percent reported having less time to interpret lab and scan results, and 16 percent reported experiencing less interaction with staff.4 Provider Survey, 2019

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In another study, 71 percent of nurses were less satisfied with the amount of time they spend on the phone for insurance matters, such as PA.8’s 2019 Nurse Survey.

Potential shipments through an existing PA workflow can help the provider anticipate the additional work that is often created when the PA requirement is not met before the request is declined at the pharmacy. Submitting requests to the PA while prescribing a drug often results in significantly faster completion, giving providers more time to do the work they want to prioritize.

The increased use of ePA’s service provider also has positive effects on the rest of the network. When the provider submits the authority notice electronically, he informs the health fund and the pharmacy sooner. Communication and coordination between the network

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