PA-LogicEnd to End Prior Authorization Workflow Platform
Best Practice Capabilities
- Efficient and transparent processes
- Industry regulations and standards compliance
- Greater managerial insight
- Detailed case auditing information
- Actionable program and plan-by-plan reports
- Maximum flexibility to meet complex plan and program hierarchy configurations
PA-Logic includes these features:
Member & Drug Driven Clinical Criteria Presentation
Ensures appropriateness and quality (right drug, right dose, right quantity, and correct frequency)
Viewable audit trail that tracks request changes by user, date, and timestamp
Integrated Drug Lists Management
Drives business rules associated with formulary rules specific to a member’s benefit. Examples include: step therapy, quantity limits, or PA required
Integrated Fax Management
Attaches faxes to PA requests and creates efficiencies for sorting, labeling, and time stamping all incoming requests and notifications
Pushes providers to the preferred formulary and alternative agents and collects required information to quantify the value to your customers
Appeals reviewers can view a consolidated and complete record including all notes, documentation, criteria review, and other relevant data.
Outbound Call Documentation
Outbound call codes and notes available for reports.
Faxed/printed notifications generated at regulatory mandated steps within the workflow.
Search by member/patient, physician, or request ID for a detailed record of all requests containing notes, viewable fax images, and inbound and outbound documentation and notifications.
Wide array of on-demand standard and ad-hoc reporting capabilities.
Integration with PBMs
SFTP connection for secure submission of batch files. Optional Manual upload to PBM claim system by HDI or client staff is available.
HDI has a fully-staffed PA Call Center to provide review services from intake to notification or as a supplement to the client’s review team. HDI’s PA Call Center is staffed by technical and clinical support specialists who consistently provide top quality customer service to our PA clients and their customers.
HDI’s Call Center team consists of clinical personnel, including pharmacists, nationally certified pharmacy technicians (CPhT), and administrative personnel providing high-quality service to clients and their member and provider communities.
The PA Call Center operational teams have a mixture of skill sets to ensure the appropriate level personnel perform each function at the right time in the coverage determination process. Personnel are trained continuously on clinical topics, administrative and operational subjects, and security policies and procedures, such as HIPAA regulations.