CoverMyMeds is NantHealth's Preferred Method for Receiving ePA Requests

NaviNet has partnered with CoverMyMeds to create Drug Authorizations, a HIPAA-compliant solution that allows you to quickly find and submit prior authorization (PA) requests for all medications and all plans, including Medicare Part D and Medicaid.

Electronic prior authorization is an electronic process established in the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard that enables patient and drug-specific PA criteria and a real-time approval for medication PA.

There is no additional cost for using Drug Authorizations with your NaviNet software. CoverMyMeds remains free for health care providers and pharmacists by partnering with health plans, PBMs and pharmaceutical manufacturers. These organizations support free use for providers because ePA improves efficiency and speed to therapy, factors likely to positively impact medication adherence and improve outcomes.

We work hard to take every step necessary to protect health-related data. All information transferred to and from CoverMyMeds is encrypted through SSL (Secure Sockets Layer) technology, up to and above the industry standard. Our servers are managed and backed up securely, among other safeguards. Our Terms of Service comply with insurance plan rules, as well as Medicare, Medicaid and HIPAA guidelines.

Your demographic and patient information is protected by our Privacy Policy and only used to help you complete PA requests for your patients. Individually identifying patient data is not shared with any other party, including our clients.

To get started, log in to your NaviNet portal and click on "Drug Authorizations" under the "workflows" tab. A pop-up will ask you to verify your profile information. Click "Edit," add your contact information and click "Save and Return to Dashboard." Once your information is confirmed, you can start submitting PA requests.

Most PA requests start at the pharmacy. The pharmacist begins the PA (with nearly all patient and prescriber information pre-populated), but leans on the provider to complete it and send to the plan for a determination.

To complete one of these pharmacy-initiated requests:

1. Go to your Drug Authorizations page and click "Search by Key"
2. Enter the key, patient's last name and date of birth.
3. Click "Enter Key."

CoverMyMeds uses a combination of state, drug and plan information to find the right request for all commercial, Medicare Part D and Medicaid plans.

On your Drug Authorizations page, click the button that reads "Create New..."

1. Enter the medication name and choose the strength from the drop-down menu.
2. Enter the patient’s state.
3. Enter the BIN, PCN and RxGroup number for the patient’s insurance plan, typically found on the front or back of the patient’s insurance card. If you do not have the patient’s current insurance card available, you may enter the plan or PBM name as well.

Note: The BIN, PCN and RxGroup numbers will yield the most accurate results. If more than one form populates, choose the one that best fits the patient’s circumstance.

Once a request has been successfully sent to the plan, all plans will respond to you directly via fax. Integrated plans, representing 80 percent of U.S. prescription volume, will also respond electronically on the website (often within moments).

Archiving provides an easy way to organize your PA requests and keep your drug authorizations page up-to-date. You should archive a request when the plan has notified you of a determination.

To archive a request:

1. Go to your Drug Authorizations page and open the request you want to archive.
2. Click "Archive" on the left side of the page.
3. Choose an outcome of "Approved," "Denied," "Not sent to plan" or "Don’t know outcome."

A key is an eight-character alpha-numeric code that identifies one specific request. The Key is located at the top of the page in the blue bar after you open a request.

The Renew feature dramatically reduces time spent filling out PA requests for returning patients. With the click of a button, you are automatically given the most up-to-date form, with all relevant information from the previous request replicated onto a new one. You can also quickly review patient, prescriber and medical information, and make updates where necessary before sending to the plan.

To use the Renew feature, follow these steps:

1. Open the request you’d like to renew from your Drug Authorizations page and click "Renew" in the left panel. If renewing an open request, click "More Options" to reveal the "Renew" button. Archived requests will show "Renew" in the left panel without clicking additional buttons.
2. A pop-up box will appear with information from the previously submitted request. When you are ready to renew the request, click "Create Renewal."
3. After the new request appears, review each section and update the information where needed. Click the blue boxes to the right of each section to confirm.
4. Once each box is checked, click "Send to Plan.".