The Future for Prior Authorization

Welcome to the electronic Prior Authorization (ePA) information section! This section is focusses on the current prior authorization process and how it could be improved. It contains information about electronic prior authorization, the challenges it will solve in the current, largely manual process and some of the barriers to adoption.

The Future for Prior Authorization

An ePA solution offers a compelling business case over the current paper, fax, and mail-based prior authorization claims process.

Prior authorization stakeholders can complete prior authorization claim forms, collect signatures, attach medical records, and submit claims through a single online ePA platform that transmits claims documentation to the appropriate payer through a secure link.

Payers receive claims when they are received electronically by their portal. There are several benefits to this first generation ePA solution. It will mitigate administrative time and cost pressures in the current prior authorization process by:

Housing all claim forms for all participating payers in one online system, so that prior authorization stakeholders complete the correct claim form for the right drug and indication.
Allowing each patient and prior authorization stakeholder to complete their portion of the claim Form or attach the required supporting information on one system.
Flagging missing information before a claim is submitted so that claims are received without the need for unnecessary correspondence to fill in missing information.
Allow electronic communications for any additional information requirements rather than fax or mail communications.
Improve decision time for patients, allowing them to start on therapy to treat their condition earlier. This can have positive workplace impact through presenteeism and return to work.
Improve the ability of payers to collect and analyze claims data.

The interest in adopting a first generation ePA solution is building as the burden of prior authorization claims increases, and there are mounting pressures to adopt a more efficient process. The adoption and implantation of an improved process is in sight.

A Canadian Solution

A made in Canada ePA solution is now available to prior authorization stakeholders and payers. It delivers efficiencies in the preparation, submission, and communication process for prior authorization claims.

There will be implementation and adoption challenges to overcome as there are with any new system or process. However, the good news is that this user friendly first-generation single source, agnostic solution has been developed with the needs of multiple stakeholders at the forefront and therefore can be relatively easily adopted by all stakeholders over time.

Some of the concerns about implementing ePA addressed by the solution include the ability for:

Each payer’s unique information requirements for online claims submission
Multiple stakeholders to participate in uploading appropriate patient information
Adding multiple signatures
Physicians to securely manage data transferred from electronic patient medical records (EMRs)
Claim submission requirements including signatures to be collected and transmitted to payers securely.

With these provisions and security checks a first generation ePA solution has many advantages over the current paper/fax-based process and addresses the concerns that have been historically raised and prevented an ePA solution for specialty drugs in Canada.

Electronic Prior Authorization

The Future for Prior Authorization

A Canadian Solution