Smartphrases
Additional Info Needed from Provider or Per Payor
.rxadditionalinfoneeded
Denial for Traci/desginee to review for next steps
What is Denial to Review
Venofer
J1756
Folder for Payer Updates
Payer Updates
Automatic approval is received immediately after submission
.rxautomaticapproval
Case sent to initiator to review (ex. denial, more info needed) usually from a fax or follow up call
What is a case to review
Aranesp
J0881
Folder for templates
Templates and subject Lines
Beacon Order Repopulates WQ & no submission is needed
.rxbeaconorderreview
Response from payer that drug is approved and must be dispensed from an outside pharmacy.
What is Prior Auth Approved: Outside pharmacy/Whitebag (drug name)
RITUXAN IV
J9312
Folder for smartphrases
Misc Auth Documents
Peer to Peer or Appeal is sent to Provider
.rxpeertopeer
Response from payer that a Peer to Peer is required. Email that goes to provider
Prior Auth Denied: Peer to Peer Requested
Euflexxa
J7323
Folder for Biosim List
Payer Auth and Preferred Product Lists
Clinical Trials Patient
.rxresearchstudypt
Email that the prior authorization is delayed from being submitted (ex. need notes signed, clarify clinical info)
Prior Auth Delayed: Additional Info Needed
BOTULINUM TOXIN TYPE A
J0585
Folder for Clinical Policies
Payer Clinical Policy Links