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New Web Prior Authorization Tool Debuts
 This
quarter, Humana’s Clinical Guidance Organization will roll
out a new, online prior authorization (PA) tool for the most commonly
prescribed medications that require PA. The new Web PA tool, available
to providers using www.humana.com,
will save time and eliminate confusion for physicians and members,
said Michael Seiler, project manager for Humana’s Center for
Consumer Messaging.
The online tool will allow physician
practices to submit PA requests online via the provider section
of www.humana.com.
Initially, the 10 most-prescribed medications requiring PA (see
box for a detailed list) will be available for online request. By
automating the prior authorization process, the Web PA tool will
add efficiency and decrease turnaround time.
Instant approval
possible
Previously, prescriptions requiring prior authorization had to be
phoned or faxed to Humana’s Clinical Pharmacy Review (HCPR)
group.
“The old method requires a lot
of follow-up from providers,” Seiler explained. “With
Web PA, physician practices and other medical offices can save time,
save money and receive prior authorizations smoothly and quickly.”
The new Web PA system will require the
same information physicians currently provide about members and
the medication being prescribed. The online system will guide prescribers
through a series of questions. If those questions lead to an “approved”
status, then the request will be approved immediately.
If the responses to the questions are
unclear for any reason, the Web PA system will notify the prescriber
that the request requires more review.
“With Web PA, members will be able
to leave the physician’s office knowing if their request has
been approved,” Seiler explained. “Incidents of the
member going to pick up a prescription, only to find the pharmacy
doesn’t have it, won’t happen. They will have an answer
immediately online.”
Faster turnaround
for all requests
In addition, Seiler estimates turnaround on requests that require
additional review will be somewhat faster than with the old offline
system. Because Humana’s pharmacy review staff will no longer
be managing routine approvals manually, they will have more time
to review other requests.
Although it has been designed to be user-friendly,
Humana will send providers information explaining how to access
and use the Web PA tool.
Quick Take
- Look for Humana's new Web PA tool online
in early 2007 for providers using Humana.com.
The tool will become available for Availity users in the
coming months.
- The most frequently prescribed medications
will roll out first. Request PA for other medications via
fax or phone for now.
- The online tool will ask for the same
information about the prescription as the current system.
- Many prescriptions will be approved
immediately.
- If further review is needed, physicians
and members will know instantly.
- Humana will send information directly
to physicians during the first quarter of 2007.
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Drugs Available for Online Prior Authorization
The first phase of the Web PA system will
include the 10 most-prescribed medications. Ultimately, all
medications requiring a prior authorization will be available
for online pre-authorization. The most prescribed are as follows:
- Celebrex® (celecoxib
capsules)
- Protonix (pantoprazole
sodium)
- Mobic® (meloxicam)
- Byetta® (exenatide)
injection
- Nexium® (esomeprazole
magnesium)
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- Lamisil® (terbinafine
hydrochloride)
- Aciphex® (rabeprazole
sodium)
- Prevacid® (lansoprazole)
- Norvasc® (amlodipine
besylate)
- Omeprazole 20mg
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