Submitting a Prior Authorization using the CoverMyMeds integration (Web)

Initiate PA | Complete Request | View Response | View Existing Request | Related Articles

DrChrono has implemented a CoverMyMeds (CMM) new enhancement, Electronic Prior Authorization (ePA). The improvement will allow for a Prior Authorization to be submitted to the Payer directly from the "send eRx" page, making it quicker for a patient to immediately begin or continue treatment with as little delay as possible.

Key Enhancements

• Information will be sent to the provider indicating whether Prior Authorization is required for a medication.

• Patient information will be sent to CMM’s allowing the provider to submit an ePA request to the payer through CMM’s platform.

• ePA message populates in the DrChrono message center.

Workflow Overview

1. Initiate PA Request from Send eRx page
2. PA Request & Responses are saved under:  Patient Chart > Demographics > Authorizations
3. Payer Responses are forwarded to the Message Center, tagged with the patient's name.

Initiating a Prior Authorization Request

• Open the Patient Chart
• Navigate to Send eRx (left menu bar) 
• Enter all required fields:
  • Medication
  • SIG
  • Dispense
  • Dispense Unit
  • Days Supply
  • Diagnosis Code (must exist in the Problem List)
• If a PA is required, the Initiate PA option will appear:
  • Click Initiate Standard Request or
  • Click Initiate Urgent Request
    • Urgent = Payer must respond within a specified timeframe (typically 24 hours)
• If an existing PA request exists for the selected medication, a pop-up will notify you. Otherwise, continue to the next step.

Completing a Prior Authorization Request

You can complete the PA request from either the Message Center or the Authorizations tab in the patient's chart.

Option 1: Via Message Center

• Click the Envelope icon (top-right of the screen)
• In the left menu under ERX, select Prior Authorization
• Click the message titled START PA
• In the message, click Start PA
• You’ll be redirected to the Prior Authorization Request screen
• Complete all required fields
  • Attach supporting documents (e.g., clinical notes) if necessary
• Click Submit Request

Option 2: Via Authorizations Tab in Patient Chart

• Go to Demographics > Authorizations
• Find the relevant medication request with a status showing Open
• Click the three dots (...) under the Action column
• Select Send PA
• Complete all required fields
  • Attach supporting documents (e.g., clinical notes) if needed
• Click Submit at the bottom of the form

Viewing PA Responses from the Payer

• Navigate to the Message Center
• Under the ERX section, click Prior Authorization
• Select the message associated with the patient's name
• Review the response type:
  • Approved
  • Complete More Questions
  • Denied
• Payer Notes and attached files (e.g., denial reasons) are viewable at the bottom of the response message.

If the Response Requires More Information

• Click Complete More Questions
• Provide the additional information requested by the payer
• Click Submit PA again

Example Payer Responses

• Approved:  PA Approved- Flonase 50mcg/inh nasal spray
• Complete More Questions
  • Click the Complete More Questions button 
  • Answer all follow-up questions
  • Click Submit
• Denied: PA Denied- Flonase 50mcg/inh nasal spray

Viewing Existing PA Requests

Open the Patient Chart

• Navigate to  Demographics > Authorization
• Under the Action column, click the three dots (...) to:
  • Send a PA
  • Cancel a request
  • Archive a request
  • View Payer Response

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