athenahealth has teamed-up with CoverMyMeds (CMM) to automate the electronic prior authorization (ePA) process for providers using the athenaClinicals electronic health record service.
It is estimated that 185 million prescriptions a year in the U.S. require prior authorization from payers, 40 percent of which are eventually abandoned. One of the reasons is the cumbersome process used to determine insurance coverage — it is time-consuming and involves phone calls and faxes between pharmacy, provider and health insurer.
To help alleviate this burden, athenahealth and CoverMyMeds have worked together to integrate CoverMyMed’s ePA platform software into the workflow of athenaClinicals for a fully-integrated experience with features including auto-population of ePA requests for medications and the ability to receive real-time determinations from partnered health plans.
With this integration on board, athenahealth physicians will be able to initiate prior authorization requests electronically, thereby eliminating the need for tedious paperwork, faxes, and follow-up calls, while helping patients receive the medication they need more quickly. Early adopters of ePA on athenaClinicals have cut their average prior authorization determination time by two-thirds — from nine days to three — while administrative data entry has been reduced by half.
“We’ve tackled some of the most onerous, revenue-draining tasks on behalf of our clients- patient insurance authorization, insurance denials, and patient scheduling-to name a few. And, as an open cloud platform, we can introduce new offerings at scale in contrast to siloed legacy systems,” Kyle Armbrester, chief product officer at athenahealth, said in a statement. “Through partnerships with companies like CoverMyMeds, athenahealth will continue to meet the demands of its providers while helping them optimize care management and navigate the business of healthcare.”
Scott Gaines, SVP and general manager, provider solutions at CoverMyMeds, is also pleased with the deal which, he says, will work for both physicians and patients. “By integrating the ePA process into the workflow, we’re able to facilitate real-time determinations and reduce the chances of patients leaving the pharmacy without their prescription,” Gaines said.