Electronic prior authorization for pharmacy

Starting August 31, 2020 you'll have the option to submit prior authorization requests for your Priority Health patients (all plans) electronically, either directly within the Electronic Health Record (EHR) or by using the Surescripts prior authorization portal.

You aren’t required to submit pharmacy prior authorizations electronically. We also accept pharmacy prior authorization requests submitted via fax or by phone.

Electronic prior authorization: An overview

We recognize that our provider partners spend substantial time on prior authorizations, and that it’s one of their most common pain-points. Our partnership with Surescripts allows you to obtain prior authorizations for drugs, when required, electronically. This eliminates the need for time-consuming paper forms, faxes and phone calls, while allowing us to return decisions to you faster.

What are the benefits of using electronic prior authorization?

Electronic prior authorizations streamline the prior authorization process for both you and Priority Health. As a provider, you can save time and increase efficiency, as well as reduce administrative costs associated with faxing (or calling-in) prior authorizations. In addition to submitting requests electronically, you can also check on request status without having to call us. It also helps our pharmacy team streamline care decisions, so your requests can be completed faster. In turn, this creates a positive patient experience that can increase medication adherence and improve outcomes.

How do I submit a prior authorization request to Priority Health electronically?

There are two solutions for providers who would like to use electronic prior authorization. If you’re not sure which option applies to you, you can contact your dedicated provider performance specialist or our pharmacy call center. 

1. Submit prior authorizations electronically within the electronic health record (EHR)

Providers who have Surescripts electronic prior authorization integrated in their EHR workflow can complete prior authorization requests directly within the EHR and route them to Priority Health for approval. Learn more about how electronic prior authorization within your EHR works.

2. Use the Surescripts Prior Authorization Portal

Providers who do not have Surescripts electronic prior authorization integrated in their EHR workflow can use the Surescripts Prior Authorization Portal to respond to prior authorization requests or process request prospectively. Within the portal, they’ll be able to complete question sets and route them to Priority Health for approval. Learn more about how the Surescripts Prior Authorization Portal works.

Learn more

Resources for providers who are using electronic prior authorization through the EHR

Resources for providers who are using the Surescripts Prior Authorization Portal

Getting started with ePA 

ePA via the Surescripts Portal

Start using the Surescripts portal to obtain prior authorization for drugs: 

ePA via your EHR

Your EHR is likely able to submit authorization requests for drugs through ePA. To find out if this functionality is included with your EHR, or to have it added, contact your EHR provider.