Electronic Prior Authorization Accelerator Overview
Product Overview
Electronic Prior Authorization (ePA) integrates directly with provider vendor systems, enabling healthcare professionals to easily obtain prior authorizations at the point of care. The prior authorization messages are designed to support the exchange of information obtained from the electronic health record system. The messages allow for the use of coded references, increasing the opportunity for interoperability. It is important for both provider vendors and PBM/payers to implement ePA using the most automated system possible to ensure timely responses to each of the messages.
About this Guide
Surescripts created this document to assist provider vendors in implementing the Electronic Prior Authorization Accelerator, which is based on the NCPDP SCRIPT standard for ePA.
The audience for this document includes any customer responsible for integrating the Accelerator within an existing provider vendor system.
Notes:
- The "Electronic Prior Authorization Accelerator" may also be referred to as "the Accelerator" throughout the rest of this guide.
- The terms PBM/payer or processor, who acts on behalf of the PBM/payer, are referred to as PBM/payer throughout this guide.
- The term third-party processor is used to describe the following: A third-party that processes prior authorizations (PA) on behalf of the PBM/payer or health plan.
- A health plan that processes their own PAs rather than delegating PA processing to their PBM/payer.
Document References
Please reference the following documents when reading this guide:
Surescripts provided materials |
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Surescripts Directory 6.2 Implementation Guide |
Error Guidance Supplement - Provides common errors and specific recommendations related to SCRIPT TransactionErrorCodes(s), DescriptionCode(s), and other errors experienced on the network. |
Electronic Prior Authorization Translation Matrix - Provides details on translation between different versions of the Surescripts implementation of the NCPDP SCRIPT standard. |
External materials to be obtained by the customer (available at www.NCPDP.org) |
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NCPDP SCRIPT Standard 2023011 files (please note that the schema files version may change and will not be considered final until published in the Generally Available guide):
Note: The XML Standard only updates when the guide changes. The latest version is 2022071. NCPDP does not retroactively update XML versions with each new SCRIPT/Specialized Standard. This Standards Matrix shows the XML Guide version for each Standard.
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NCPDP SCRIPT Implementation Recommendations (latest version) |
NCPDP External Code List 202301 (NCPDP online tool) |
NCPDP SCRIPT
This guide utilizes the NCPDP (National Council for Prescription Drug Programs) messaging standard Prescriber/Pharmacist Interface SCRIPT version 2023011 as a baseline. To become an NCPDP member, please go to https://www.ncpdp.org/Membership.aspx.
The NCPDP SCRIPT Standard 2023011 package contains a complete list of fields and additional requirements. Customers should read and comprehend the associated standards prior to reading this guide.
NCPDP is an American National Standards Institute (ANSI) accredited Standard Development Organization. The NCPDP “SCRIPT” standard is a copyrighted document and may be obtained by contacting:
NCPDP 9240 E. Raintree Drive Scottsdale, AZ 85260-7518 Phone: (480) 477-1000 Fax: (480) 767-1042 https://www.ncpdp.org