Electronic Prior Authorization (ePA) - DrFirst

To learn more about Patient Advisor and electronic prior authorization (ePA), please review the following resources:

What is Patient Advisor?

The Patient Advisor gives physicians a suite of advanced clinical, behavioral, and financial support tools designed to inform and improve medication adherence and disease self-management by high-risk patients.

Patient Advisor enables providers with patient medication adherence rates, electronic prior authorization, real-time pharmacy benefit checking, and evidence-based patient support tools to help solve underlying causes of non-adherence.

What is ePA?

This video explains more about Electronic Prior Authorizations

How do I use Patient Advisor and ePA?

Please review these training materials:
Patient Advisor Training Video
ePA Training Video
  Medication Adherence and ePA Training Manual (download the below document)


Downloads

DrFirst Patient Advisor Manual.pdf





















 

 

 

 

 

 

 

 

 

 

 

Patient Adherence, Education, Co-Pay Savings, 

Adherence Plans, Clinical Messaging and Electronic 

Prior Authorizations (EPA) 

 

SPM Patient Advisor Toolbar Manual 



Patient Advisor Training Manual

2016

 




 

 


Contents

 

Introduction ............................................................................................................................................................................ 3

Accessing Patient Advisor ....................................................................................................................................................... 3

How to View and Interpret the Patient Scorecard ................................................................................................................. 3

Patient Support ....................................................................................................................................................................... 6

Clinical Messages .................................................................................................................................................................... 8

Coupons and Co-Pay Savings .................................................................................................................................................. 9

Adherence Plan Letters ......................................................................................................................................................... 10

Electronic Prior Authorizations (ePA) ................................................................................................................................... 11

Medication Fill History .......................................................................................................................................................... 15

Practice Preferences ............................................................................................................................................................. 18


 

 




Patient Advisor Training Manual

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Introduction 


Patient Advisor is an adherence platform within eRx/EMR/HIS solutions designed to improve patient outcomes. Patient

Advisor analyzes data to provide evidence-based patient support (education and co-pay savings) and deliver multi-

faceted clinical messages at the point of encounter.


Supported Browsers:


Patient Advisor is currently supported on the following browsers:



IE: version 8+, newer version preferred


Firefox: version 4+, newer version preferred


Chrome: version 10+

newer version preferred


Safari: version 5+

newer version preferred


Opera: version 11.1+

newer version preferred

 

Accessing Patient Advisor 

 

1)


To access Patient Advisor you must log launch into the Medreview-ERX Application.

2)


Once within a patient’s chart you will automatically see the Patient Advisor toolbar, normally located towards

the middle of the page. 

3)


There are four tabs you can navigate through to utilize patient scorecards, patient support tools, clinical decision

support tools and ePA+.  

4)


In addition to the tabs, there is also a service that alerts the physician of a coupon, co-pay savings or adherence

letters for the electronic prescription that was just written for their patient. 

 

 

5)


Note: If you have recently minimized the toolbar by clicking the double-arrow to the right, you will need to

expand it to view the toolbar. To expand the toolbar, click the bottom highlighted below on the right. 


 

How to View and Interpret the Patient Scorecard 

 

1)


The patient scorecard card is a tool to give you an overview of the patient’s adherence with their medication

regimen and lists the patient’s active medications. 


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2)


On the Patient Advisor toolbar if your patient has any gaps in filling their prescriptions the Patient Scorecard tab will

appear orange, meaning your patient‘s adherence rate dropped below 80%.  

 

 

3)


If the toolbar is collapsed and there is an alert for the patient, you will see the notification on the tab to the far right,

seen below:


4)


For a patient without gaps in their medication regimen the Patient Scorecard will appear unchanged.

5)


When you click on “Patient Scorecard” tab, the Patient Advisor scorecard will display. The screen will give you the

adherence.



Adherence Rate  

Adherence Rate is a calculated based on a prescription plus two fill events and expressed as a percentage displayed

below the name of the drug in the chart. The calculation is made for each prescription with the same generic name

regardless of dosage at the time of patient encounter.  


Green Dot – Adherence rate is 80% or greater, i.e. No risk for non-adherence. Patient adherent to treatment

regimen most or all of the time.


Yellow Dot – Adherence rate is 60% - 80%, i.e. Elevated risk for non-adherence. Patient not optimally following

treatment regimen; offer education and/or evaluation.


Red Dot – Adherence rate is less than 60%, i.e. High-risk for non-adherence. Patient not following treatment

regimen; requires adherence evaluation.


N/A – there is insufficient data to calculate an adherence rate. A minimum of two “fills” for a single prescription

are required in order to calculate the adherence rate and for medications that are PRNs.

 


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1)


Interpreting the Medication Adherence Scorecard:  

a.

 

The Patient Scorecard tab alert will be triggered when the patient is on a drug for which his/her

adherence rate is less than 80%.

b.

 

In the upper right corner of the scorecard, the user can select different views: 2 Months, 6 Months, 1 

Year and 2 Years. The default view is six months and the scorecard displays two years of fill history.

c.

 

Brand name drugs will have the first letter capitalized. Generics will be displayed in lower case. 

d.

 

Medications will be sorted by ascending adherence rate with the lowest percentage on the top of the

list. N/A will appear at the bottom of the list. Drugs marked as N/A do not have sufficient fill data to

show an adherence rate.

 

 

e.

 

F

(Actual Fill Date) – When you hover over the icon you will be shown drug name, drug strength, fill

date, supply, refills remaining, prescriber and available pharmacy information. 

 

f.

 

R

(Expected Refill Date) – Indicates that there was a refill event that should have occurred but was

missed. When you hover over the icon you will be shown the date it was expected to be refilled based

on the original prescription. The refill takes into account when the prescription was actually filled. 

g.

 

X

(Expected Completion Date) – When you hover over the icon you will be shown completion date of

the prescription along with the name of the medication. The end date will be calculated and readjusted

based on dates the prescription was filled. 

 

h.

 

Red Bar

– Indicates the number of days between the time the patient should have had their

medication filled and the next event. This can show up between an “F” and an “F” and between an “R”

and an “F” or the end of a prescription. 

i.

 

Blue Bar

– Indicates the duration of the fill for that medication before a refill is required or when the

prescription ends. The number of days and the date range are displayed. 


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i.

 

No Gap in Rx - If there is no gap in Rx fill, then the blue bar is displayed. The date ranges for the blue bar

includes the Rx date or fill date (F) up to the DAY BEFORE the subsequent fill date or expected refill date

(R) and counts only that number of days. If the blue bar is from Rx/F to prescription end (X), the date

range includes the X date and is included in the number of days.

j.

 

Gap in Rx - If there is a gap in Rx fill, and then the red bar is displayed. The date range for the red bar

includes the Rx date or expected refill date (R) up to the DAY BEFORE the subsequent fill date (F) or R

and counts only that number of days. If the red bar is from Rx/F to prescription end (X), the date range

includes the X date and is included in the number of days.


Patient Support 


1)


Click on the second tab in the Patient Advisor toolbar titled Patient Support. This section will have education

documents available for this patient based on their active medications list, diagnoses, and lab orders. The user

can also search by term or codes.

2)


These materials are automatically retrieved when a patient has active medications (with accompanying RxNorm

codes) and/or problems assigned (with accompanying ICD9 codes) (ICD10 codes available in future build) and

LOINC codes for lab results.


3)


Within this section, labs ordered for a given patient can be entered by entering the LOINC code for the lab.

4)


Within the Patient Support tab there are, four different selectable tabs available, shown below:

a.


Diagnosis

b.


Medication

c.


Labs

d.


Search




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5)


Clicking on a category tab, will then illuminates it in "white" and the results will be displayed.

6)


Within the "Diagnosis" tab the results for the patient’s diagnosis codes are listed.

7)


If none of the first three tabs contains values, then the ‘Search’ tab will be the best way to find education

materials.


8)


The medication, lab or diagnosis description will be displayed on the left and the corresponding code and/or

value will be listed on the right. The search for education can be done based off the description, code type, and

value.

 

9)


When the user clicks the 

 button, all education materials are retrieved and displayed in one display box.

Currently, the education resources are provided by The National Institutes of Health’s National Library of

Medicine (Medline Plus program).


10)


Clicking the

will search for available documents by code and the

will search for available documents by

description. When the user clicks either

or

, available materials will be displayed individually.

11)


Once the education material is presented, physicians are encouraged to discuss education materials with

patients. Physicians can print educational materials by clicking the print button in the upper right corner


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12)


Links displayed on the education document take the user to external sources. The source link is also available for

the user above a disclaimer message. The disclaimer message is on every content page.

Clinical Messages 


During the user workflow, clinical messages will trigger based on patient demographics, provider specialty and/or

medications.


1)


Messages will first display as an “auto-preview” message for 15 seconds in a yellow box at the top of the page.

2)


If a link is available, clicking the link will display additional content in a display box.

3)


As long as the rules supporting the clinical message are satisfied, the message will be located in the clinical

decision support tab.






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Coupons and Co-Pay Savings 

 

1)


Prescribe a medication through the eRx application. 

2)


If the prescription is a branded drug and has a coupon or co-pay savings a preview window will appear with the

savings offer. This will only appear after the prescription has been created. 

3)


The information will automatically be amended to the electronic prescription as part of the notes to the

pharmacist. If the “Notes to Pharmacist” section is being used by the prescriber, the coupon information will

not be amended to that field and the coupon should be printed separately. 

 

 

 

 

 

 

 

 

 

 

 

 

 

4)


First, a small display box will present a file which can be printed. At the bottom will be checkboxes for the

delivery option.  

5)


The user can enlarge/minimize the display box by selecting the ‘+’ / ’-‘ in the upper right corner of the display

box and close the display box by clicking on the ‘X.’ 

 

 

View of expanded co-pay savings.

6)


Radio buttons will be placed before programs when two or more program types are available (co-pay savings or

adherence plans) for the user to select the program they would like to view and it will display. The user should

then select the communication/delivery option for that program. After clicking ‘Submit’, the user can view other

program types and choose the desired delivery option. If program titles are long, the user may need to use the

vertical scrollbar to view all the programs.




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Adherence Plan Letters 

After a prescription is created, an adherence plan may display an available patient print-out if available. These letters are

typically for refill reminders. An office letter displays in the display box and additional education content can be sent to

the patient’s home on behalf of the physician at no charge.


1)


The ‘In-Office Print’ option is for materials the user wants to print for the patient.


2)


The ‘At Home Communications’ will send additional education content that is different than what is available for

print.


3)


The default ‘Patient Communication Options’ selected in the ‘Patient Advisor Preferences’ will set the default

checked options. The user can change the delivery option without affecting their default settings, if they choose.


4) The user can choose on a case-by-case basis which patients receive at home communications without impacting

default settings.









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Electronic Prior Authorizations (ePA) 


Through Patient Advisor, a user has the ability to submit Electronic Prior Authorizations (ePA). Patient Advisor will start

the prior authorization process in the back-end for prescriptions that require them. A user can click on the ePA+ tab

within the Patient Advisor toolbar to view the prior authorizations.


The available sections within the ePA+ tab are:

1.


PA Question set available – a questions set for a prior authorization is available

2.


PA Needed – a prior authorization is needed for a patient

3.


PA Submitted to plan – the prior authorization has been submitted to the payer

4.

 

PA Decision Received 

a.


PA Denied – Denied by the payer

b.


PA Approved – Approved by the payer

c.


PA Closed by Plan – Closed by the payer

Patient Advisor will automatically place the ePA+ tasks within the appropriate section depending on its status. This

makes it very easy for a user to find the task.



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If a prior authorization is needed, users can access the question sets from the insurance plans once they are available in

the ePA+ tab within the PA Question set available section. Users will be able to click on action buttons on the right hand

side within each section. In order to start an ePA from the available question set, click on the Complete Now! button.

This will populate a prior authorization question set for the user to complete and submit to the payer (shown below).


Filtering Options: 

 

Upon logging in, by default the tasks display for the practice location and provider associated with the user who logged

in. Users can select from the dropdown and click the “Apply” button. Users are also able to filter the tasks by patients’

last name by using the Search textbox and clicking the “Search” button. The tasks display under the appropriate status

headers. The “Reset to All” button clears the Search criterion and reverts the view to display all tasks for all patients. If a

patient’s chart is selected or opened, the users can click on the “Show Current Patient Only” button to display tasks for

that patient. To go back to view tasks for all patients, users can click on the “Reset to All” button. The “Update List,”

formerly the “Refresh” button, when clicked uploads new tasks or updates the status of tasks.





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ePA Status Groupings: 

 

Instead of showing all tasks in one table, the different tasks are grouped by status and users can view a count for each

task grouping when they click open the ePA+ tab.




ePA Task Details: 

 

 

The information about the tasks are the following – Patient Name, Patient Date of Birth, Drug, Prescriber Name, Date

Created and Name of whoever the task was assigned to. The action buttons display on the right.




When user clicks the “i” button located beside the drug detail, the PA Note displays showing more information about

the task such as task transaction ID, update date, patient insurance information, prescription details and notes from the

insurance plan about the requested task.





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ePA Status Notification: 

 

 

To alert the users of incoming new ePA statuses, Patient Advisor will display messages to the users.









 



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Medication Fill History 

Fill Notification in Patient Advisor is a solution that proactively identifies patients eligible for the program. It periodically

monitors and provides ready access to patients’ fill history information at the point of care to allow providers make

necessary interventions that will help patients’ adherence to their prescribed treatment. Such proactivity helps achieve

the dual goals of positive impact on health outcomes and eventual reduced healthcare costs.


In the Rcopia UI, when a prescriber completes a prescription for which the medication is eligible for the drug fill

notification program, a message window displays alerting the prescriber and provides the option to either opt in or opt

out the patient from the program.


Fill Notification Enrollment (Opt-In) Auto-display Message:




Fill Notification Enrollment (Opt-Out) Auto-display Message:



Once the patient is enrolled in the program, users can track patients’ status and progress from the new tab labeled

Medication Fill History, on the Patient Advisor Toolbar.


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When a user clicks the Medication Fill History tab, the default list displays the drug fill information for the selected

patient in Rcopia. The table consists of the following columns: Patient Information (Patient Name, Date of Birth and

Phone Number, if available), Prescription Information (Medication Name, Number of Refills and Prescription Written

Date), Fill Status, Prescriber and Actions.


The Status column has the following icons:

a.


A Green heart signifies completed fill. The fill date was provided by either the Pharmacy/PBM or by the

prescriber/patient. The hover information displays the actual fill date.

b.


A Red heart signifies missing fill. The prescription was not picked up from the pharmacy as of the expected fill

date. The hover information will display the expected fill date. The user has the option to enter fill details as

reported by patient by clicking on the red heart.


c.


A White or clear heart signifies a future fill. The hover information will display the expected future refill date.



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The Status column also contains a link to display fill history details such as expected prescription fill date, actual date,

drug name, quantity, days’ supply and source of info for the actual fill date. The user is able to print this page by clicking

the Print button.


The users are also able to select to display the list of patients depending on the criteria:

1)


Enrolled patients who have not picked up their prescription from the pharmacy on the expected fill date are

labeled Enrolled with Missing Fills

a.


Available action for the prescriber: Stop Tracking (removes the patient from the program list)

2)


Enrolled patients who picked up their prescription from the pharmacy by the expected fill date are labeled

Enrolled with Complete Fills

b.


Available action for the prescriber: Stop Tracking (removes the patient from the program list)

3)


Lastly, patients who were prescribed medications that were eligible for the drug fill notification program but the

prescriber has not taken action from the enrollment window.

c.


Available actions for the prescriber: Start Tracking (enrolls the patient to the program) and Stop

Tracking (removes the patient from the program list)


The Fill Notification table can be filtered by location. The user can select the desired location from the dropdown and

click the Apply button to update the list displayed.


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Practice Preferences 

 

1)


At this time practice preferences for the Patient Advisor Toolbar can only be changed by the practice

administrator. In future releases providers will have this capability. 

2)


For Practice Administrator - In “Options” go to “Preferences – practice:” to modify the following: 


 


a.

 

 

 

If all three are YES the toolbar will be visible along with medication adherence, education and coupons. 

b.

 

 

 

If patient education is NO the toolbar will still appear with medication adherence and coupons.

c.

 

 

 

If prescription savings is NO the toolbar will still appear with medication adherence and education.

d.

 

 

 

If patient education and prescription savings are NO the toolbar will still appear with medication adherence.

e.

 

 

 

If medication adherence is NO the toolbar will not appear but patient education and prescription savings will

be available if those are enabled.


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3)


For Provider - Since the toolbar is controlled by the practice administrator you still have the ability to control

adherence plans, patient education, prescription savings and Patient Communication Options. In “Options” go

to “Patient Advisor Preferences”. By checking off the boxes you are enabling these features in the ERX

application. 

NOTE: This preference will not be available once Patient Advisor becomes standard functionality on December

15, 2014.

 


 

 

 

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