Prior Authorization

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Not all PA programs are equal. We will help you understand the implications of a PA program’s scope and how we can make PA work better for you. With dedicated clinical experts and an easily configurable infrastructure that supports rapid implementation and scalability, our solution gives you everything you need to coordinate with providers and maximize member care while ensuring CMS compliance.

Features

PA-Logic is an end-to-end coverage determination workflow application designed especially for the complexities of today's health care benefit managers, from small plans to large Medicare Part D administrators. With PA-Logic, you gain consistency, timeliness, documentation, reporting, and reliability. And, smarter decisions lead to superior outcomes.

Consistency

Our team provides clinically-sound criteria tailored to your business rules for increasing consistency in coverage determinations.

Compliance

Auditing and process adherence are the cornerstones of our workflow solution, which makes all actions uniform and documented.

Service

We focus on high-quality service delivery that creates strong provider relations while ensuring appropriate prescribing behaviors.

Speed

We send out decisions as soon as your clinical criteria requirements have been reviewed.

Benefits of our expertise

We take PA seriously. Our experts work with your business rules governing the usage of clinical criteria, turnaround times, and automated notifications so that your PA process meets or exceeds industry standards and CMS compliance. We maximize the value of your program by empowering you focus on your business plan instead of struggling with clunky manual processes and outdated legacy systems.

As the PA experts, we are here to help you find options for the management of your program’s organizational risk, member health, and business economies. Enhance your PA review process by reducing processing time and administrative waste. Let our team of clinical, technical, and professional staff streamline one of the most painful components of your pharmacy administration.

What you get:

  • Greater efficiency with multi-channel submission into a single order log
  • Stronger, more secure segregation of duties with role-based work queues
  • Clearer communications that are configurable by line of business, determination type, and language
  • Robust reporting that supports CMS requirements, creates full audit trails, and quantifies the value of your prior authorization activity
  • Proven success with integration partners such as PBMs, provider portals, and other health data vendors