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MedHOK's Pharmacy Prior Authorization Solution
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Pharmacy Prior Authorization

Solution Overview

MedHOK’s Pharmacy Prior Authorization solution comes out of the box fully CMS-compliant for Medicare and is easily configurable for other lines of business, including Medicaid, the Exchanges and Commercial business. Our cutting edge platform allows for real-time monitoring of activity and promotes a proactive approach to workload management. MedHOK is fully integrated with First Data Bank and Medi-Span for up to the minute FDA and manufacturer guidelines. MedHOK is also capable of integrating with all major PBM’s. Our solution includes:

  • A seamless intake process with re-route and forwarding capabilities
  • Automatic member eligibility verification
  • Configurable decision trees to aid in decision making process
  • Auto effectuation of approvals in client claim system
  • Automatic correspondence generation based on case status and/or action taken
  • Real-time dashboard reports and alerts for proactive monitoring
  • Pre-built reporting tools as well Business Intelligence tools for ad hoc reporting needs

Customers use this solution to:

  • Simplify the review process for associates, members and providers
  • Create custom, business-specific workflow rules and routing
  • Remain compliant with federal and state regulations
  • Manage utilization management edits with minimal impact for protocol and/or formulary changes
  • Integrate with IVR and fulfillment vendors to ensure appropriate outreach and communication

Have You Considered ...

You may also want to manage appeals-related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these other MedHOK pharmacy solutions:

Download Product Spec Sheet

100% Out-of-the-Box Compliant

Pre-configured to be fully compliant day one with Medicare, Medicaid and Commercial/Exchange LOBs

Auto-Effectuation

Integrates with PBMs to auto effectuate claims for approvals, removing administrative burden

Pre-Built Workflows

Out-of-the-box best practice workflows to ensure compliance and increase efficiency

See How Industry-Leading Payers Use MedHOK's Pharmacy Prior Authorization Solution

Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to schedule your custom demo.

Rx Prior Auth Demo Request