Home Forums Discussions General Discussion Prior approval of meds

I am trying to see if there's any AI help with prior auths for meds. We use CoverMyMeds but it can take 5-30 minutes to clear one request. Several EMR's have them built in:
o Epic Payer Platform: Uses AI (via modules like "Coverage Requirements Discovery" and "Prior Auth") to check PA needs in real-time, auto-populate forms, and track status within the Epic workflow. (Widely adopted by large health systems).
o Athenahealth: Leverages AI/ML within its EHR/RCM platform to automate PA initiation, identify needed documentation, predict delays, and streamline communication. Focuses on reducing administrative burden.
o eClinicalWorks: Incorporates AI-driven PA tools within its EHR, aiming to automate form filling and status tracking.
Also mentioned is DrFirst which I believe was our last e-prescribing company. They have something that integrates with EMRs.
Anyone know of any software that integrates with AC?

Good question Lane, I do not know of any free standing PA platform that would integrate. My staff uses CoverMyMeds as well. Interesting those 3 have it built in. I looked at an EHR, Charm, and they also have similar. They do not say it is AI driven. It is "powered by SureScripts" which Amazing Charts also uses. Maybe we can get some input from Mark@AC?

From Charm: " Electronic Prior Authorization allows you to improve and simplify your current workflow, which might look like a disruption today is ultimately an upgrade to a smoother and better process. We embed all functionality directly into your clinical EHR workflow and have prioritized features that help you avoid unnecessary work. Submit the prior authorization electronically and typically get approval within 60 seconds.

It’s powered by Surescripts that connects to more PBMs and payers than other options. Today, it is already linked to 89% of covered lives in the United States, and it is growing every year."

You know what I miss? No AI or great programming feat involved. I miss the ICD look up via the internet from the chart. This used to be just tot he right of the search diagnosis. It was removed because it was a possible security weakness, but it was handy.