Appealing a Prior Authorization

a pbm/payer may allow a denied prior authorization to be appealed directly from the prior authorization if enabled by the pbm/payer, the denied prior authorization response will display an option to accept the denial or appeal pa case id – patient name please note that although the case id is not displayed here, it will be shown in the task history and in the corresponding appeal response this may be required if any documents are requested by the pbm/payer, or other forms of manual communication are required pa note – this free text box allows a user to indicate why they are appealing the pbm/payer’s response the pbm/payer may respond with an approval/denial or may request additional information through the use of additional question sets appeal button – selecting this will allow the user to submit the appeal to the pbm/payer options drop down – the option’s drop down menu allows the user to return to worklist or task history