Save time, submit prior authorization requests electronically for pharmacy benefit drugs

Providers can now use their electronic health record or CoverMyMeds^®** to submit prior authorizations for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members with commercial pharmacy benefits.

Electronic prior authorization, or ePA, replaces faxing and phone calls so providers can focus less on administrative tasks and more on patient care. Other benefits of ePA include:

• Automatic approvals for select drugs.
• Turnaround time is improved for reviews and decisions.
• Easy to use for prescribers, nurses and office staff.
• All documentation and requests are kept conveniently in one place.

Here are some answers to frequently asked questions about ePA:

Why should I use ePA?
You’ll save time. You can send 11 ePAs in the time it takes to fax just one (based on Comcast and Verizon broadband rates and fax speed of 33.6 kilobits per second), and patients can receive medications faster.

The process is easy and intuitive, and providers and authorized personnel can use the electronic health record tool or log in online.

What is the cost of ePA?
Some electronic health record vendors charge an additional fee for this added functionality. There’s no cost to use online portals.

What makes ePA better?
Both the online portals and ePA within your electronic health record make it easy to submit fully electronic requests and give you:

• Clear direction on clinical requirements
• The ability to attach documentation if required
• Secure and efficient prior authorization administration all in one place
• The capability to proactively renew existing prior authorizations up to 60 days before they expire
• Streamlined questions, asking only those needed for the prior authorization, unlike fax forms.

How do I get started?
Electronic prior authorization can integrate into your current electronic health record workflow. Check with your vendor to ensure you have the latest software version enabling ePA.

If ePA in your electronic health record tool is currently unavailable, create a free account online for the tool that works best for your office. Registration is free and takes only a couple of minutes.

To complete an ePA, follow these steps:

1. Go to covermymeds.com/epa/express-scripts.***

• Create a free account if you don’t already have one.

2. Start a prior authorization.

• Click New Request, and enter the patient’s state and medication.
• Type Blue Cross Blue Shield of Michigan into the Plan, PBM and Form Name field.
• Select the appropriate form, and click Start Request.

3. Complete the ePA.

• Enter all demographic fields marked Required, and click Send to Plan.
• Complete the returned list of patent-specific, clinical questions marked Required.

4. Confirm the ePA process has been completed.

• Click Send to Plan again to complete the ePA request.
• After Blue Cross or BCN has reviewed your submitted prior authorization, the determination will appear in your CoverMyMeds account.

Approval decisions are often returned within moments of submission, depending on the complexity or need for further review.

For more information

• If you have questions, contact the Pharmacy Help Desk at 1-800-437-3803.
• Click here for a flyer detailing the benefits of ePA.

**Other free ePA services include Surescripts^® and ExpressPAth^®.
***Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.