3 Reasons Why “Full Service” Matters in PA Management

Healthcare providers today have a range of options when it comes to managing the ever-increasing number of prescription prior authorizations (PA).  They may choose to “go it alone” – searching for the correct submission form, completing the form, submitting the completed form and following up with the plan (often by phone). They may opt to use a “form based” third party service to find and complete the correct form, followed by the burden of follow up with the plan falling on practice staff. Or, they may choose a “full service” PA management partner. I’ve referenced PARx Solutions as the premier full-service PA management partner in past blogs; now, let’s consider what “full service” really means, and why should it matter to providers and their patients?

1. Insurance Verification: I was recently at a pharma client sales meeting when a district manager approached me with a concern about our service. She informed me that one of the practices in her district had tried using PASS (PARx Prior Authorization Support System), but that all nine of the PAs submitted were denied due to “insurance not found.” Upon hearing this, I reviewed all of the PA submissions from the practice, and found that just three submissions were placed through PASS – and all three were approved. As it turned out, the nine denied PAs were submitted using a different service.

This unnoticed error isn’t unusual from a busy practice; we have found that nearly half of all PA submissions cite incorrect patient insurance information, often due to including the medical insurance information rather than the prescription plan. As a full-service partner, PARx calls the pharmacy to confirm the patient’s prescription plan coverage prior to submission, to ensure that the PA is routed to the appropriate plan. This in contrast to a form based provider, in which case the PA is submitted to the wrong plan and so denied for insurance not found – as was the case in this example.

2. Follow-up with the Plan: Plans don’t always act expeditiously with regard to PA submissions. Often, practices need to follow up with the plan to get an answer on a previously submitted PA, or to provide additional information. Calling a plan generally results in extremely long telephone hold times (we have found typical hold times ranging from 10 to 45 minutes) before the staff member has the opportunity to speak with anyone at the plan. Most practices cannot dedicate the resources to sit idly on hold, waiting for the plan to respond to their inquiries.  With a full service partner,  follow up is performed on behalf of the practice, saving significant time for practice staff and resulting in faster PA decisions.

3. Quality of Submission: Plans frequently change the PA requirements for specific medications, as well as the PA submission forms and the process for submissions. This can become confusing for practices and result in more time being spent on the submission process, as well as frequent omissions of key information. Full service PA management partners review all submissions for completeness and accuracy prior to submitting the request to the plan. This results in a higher quality submission, leading to more approvals and better workflow management for the provider.

When considering how best to manage the increasingly complex world of prescription PAs, consider using a full service PA management partner to ensure that more patients receive the medication their provider deems best for their treatment.

Be Our Guest! Introducing GUEST PASS

By Dan Rubin, CEO

In our latest feature update, we’ve just made our free service even easier to access for physician practices.  Introducing GUEST PASS, which allows any prescriber to use PARx’s Prior Authorization Support System (PASS), without having to go through the registration process.

GUEST PASS is an excellent solution for any provider currently using inefficient PA submission methods, who wants to see the benefits of PASS but without an up-front commitment. This is a significantly growing problem for practices, as evidenced by a May 2017 MGMA Stat poll which found 86% of respondents had seen an increase in PA requirements during the past year.  Some of these prescribers may not be aware of the difference PASS has made for many providers, their staff and in the end, their patients.

GUEST PASS can be easily accessed by following these simple steps:

  1. Go to www.parxsolutions.com, and select the Submit a PA option.
  2. From the Log-In screen, click on Not Registered? Continue as a Guest User.
  3. Enter the provider’s NPI number, then follow instructions to complete and submit a PA.

Once submitted, the PARx support staff will manage the PA on behalf of the provider. Providers will receive an email with a reference code allowing them to check on the status of the submitted PA, and they will be notified when the outcome is determined.

Practices can opt to continue using GUEST PASS or they can elect to become registered users by answering a few short questions, creating a username and password, and using PARx’s electronic signature feature to create an account that is immediately available for use.  Registered users have the benefit of being able to check the status of all submitted PAs, as well as the ability to upload chart notes to PA requests, and can easily enroll additional providers to their practice account.

GUEST PASS (along with our new, easier than ever registration process) opens the door for more prescribers to experience the benefits of PASS, thereby helping more patients receive their prescribed therapy, and improving practice management.

 So what are you waiting for? Be our guest!

New Podcast Series: Meeting the Prior Authorization Challenge – A Prescription for Patients and Physicians

By Dan Rubin, CEO

As part of our dedication to providing physician practices with the insights they need to lessen the impact of PAs on office workflow and most importantly, to better ensure that patients received the medications their doctors deem best for their treatment, my colleagues and I have unveiled a free podcast series entitled “Meeting the Prior Authorization Challenge: A Prescription for Patients and Physicians“. The series consists of short, insightful conversations with members of the PARx Solutions team, doctors, and practice staff.

Prior authorizations aren’t going away, so it is essential that physician offices empower themselves to better handle the process. Who better to hear from on PAs than doctors and practice managers managing this process on a daily basis? By giving a voice to their frustrations, we hope to raise awareness of the solutions PARx offers at no cost to physician offices.

Topics thus far addressed in the podcast series include:

Episode One: What is PARx Solutions, and why do I need it?
Yours truly launches the podcast series by explaining what prior authorization are and the challenges they raise for physician practices. I also provide an overview of the service provided by PARx Solutions is and how it helps improve practice workflow and patient access to prescribed medications.

Episode Two: Prior authorizations and ophthalmology
Ophthalmologist Dr. Bingjing Roberts weighs in on the importance of prior authorization within her line of medicine and highlights how working with a PA provider has been helpful in ensuring her patients receive the prescriptions they need.

Episode Three: A practice staff member’s perspective
Ophthalmic Assistant Jeanette Key explains how PARx Solutions’ customer service team is fundamental to her practice better ensuring its patients receive the medications their physician prescribes.

Take a listen, and let me know what you think! Have a topic you’d like addressed in a future podcast? Drop a line to ariane@warnerpr.com with your suggestion and feedback.

Episode One: What is PARx Solutions, and why do I need it?

Dan Rubin launches the podcast series by explaining what prior authorizations are and the challenges they raise for physician practices.

Rubin also provides an overview of the service provided by PARx Solutions and how it helps improve practice workflow and patient access to prescribed medications.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.

Episode Two: Prior authorizations and ophthalmology

Ophthalmologist Dr. Bingjing Roberts weighs in on the importance of prior authorization within her line of medicine and highlights how working with a PA provider has been helpful in ensuring her patients receive the prescriptions they need.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.

Episode Three: A practice staff member’s perspective

Ophthalmic Assistant Jeanette Key explains how PARx Solutions’ customer service team is fundamental to her practice better ensuring its patients receive the medications their physician prescribes.

Note: This audio player is not supported in Internet Explorer 8 and earlier versions.