Integrate with the Surescripts Prior Authorization Portal API to enable prescriber staff to submit and track ePA requests without leaving the EHR

domain: surescripts.com · 6 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Access the Surescripts Prior Authorization API documentation through the Surescripts partner portal; execute partnership and data use agreements; obtain sandbox credentials and the API specification for PA request submission
  2. Implement the PA request submission workflow: collect drug (NDC), patient demographics and insurance (BIN/PCN/Group, member ID), prescriber NPI, and clinical indication (ICD-10 code); submit to Surescripts PA routing layer which forwards to the appropriate payer
  3. Retrieve payer-specific question sets dynamically before presenting the PA form to the user; render questions and required clinical documentation prompts to the prescriber or staff within the EHR workflow
  4. Submit completed PA with clinical answers; receive a tracking number; implement status polling or webhook integration to retrieve PA decision (Approved, Denied, More Information Needed) and present updates in the EHR task list
  5. On PA approval, write the authorization number and approval dates back to the prescription record; set an expiration alert so the prescriber is notified if the prescription is not filled before the PA expires
  6. For denied PAs, surface the denial reason code and explanation within the EHR; provide a one-click workflow to initiate appeal (PriorAuthorizationAppealRequest via NCPDP SCRIPT 2017071 if supported by the payer)

Known gotchas

Related routes

Submit an NCPDP SCRIPT 2017071 electronic prior authorization (ePA) initiation request through Surescripts for a Medicare Part D drug requiring PA
ncpdp.org · 6 steps · unrated
Automate prior authorization using the Da Vinci PAS (Prior Authorization Support) FHIR workflow
fhir · 6 steps · unrated
Request a patient's medication history via the Surescripts Medication History API
surescripts.com · 6 steps · unrated

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