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 connectivity and authentication implementation guide https //docs surescripts com/connectivity/home 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 http //www ncpdp org/ ) 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) xml files (schemas) 20230114 ncpdp script implementation guide v2023011 (march 2024 republication) xml standard guide v2022071 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 v2023011 script standards examples guide v10 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 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 https //www ncpdp org