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  • 1.  Prior Authorization

    Posted 07-05-2024 18:16

    Hi. I work in a family practice. The nurses do the medication prior authorization work.

    I'm wondering how PA's are handled in other settings across our country. 



  • 2.  RE: Prior Authorization

    Posted 07-06-2024 09:02

    I work for a large medical group that created a centralized medication Prior Authorization team several years ago to handle them for all the clinics. The team historically did really well getting most of them initiated within a few days, but this year has been a struggle for them with more medications needing prior authorizations and it now can take them up to 2 weeks to process the requests. Overall, though it has helped to have a defined process and dedicated group doing them for follow up.



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    Melissa Ropella
    Clinic Triage Nurse
    Fairview Medical Group
    Burnsville MN
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    Original Message


  • 3.  RE: Prior Authorization

    Posted 07-06-2024 11:14
    I do agree it's a great idea to have the RN's do the PA work as they have a better knowledge base when it comes to medication, as opposed to the MA's. But I have to admit that the idea of a designated group ( preferably made up of nurses) that specialize in PA's makes a lot of sense to me.

    I say this because the nurses are already stretched thin with triage calls, TOC calls, results calls, injections, vaccine administrations, med neb Tx's, other medication administrations, etc.

    PA work is obviously important but can be very time consuming. 

    This is why I love to get input from nurses around the country. 

    Belonging to AAACN is very valuable to me.

    Have a great weekend everyone.



    Original Message


  • 4.  RE: Prior Authorization

    Posted 04-08-2025 12:27

    Hello Melissa, 

    We are setting up a centralized PA team using the LPNs that we have in our centralized RX pool. We are looking for a more effective way to track metrics for this team. Is this something that you have established for you nurses? For context we use EPIC. You can also reach out to me via phone or email whichevers easier

    daniele.hill@emoryhealthcare.org

    4438780910



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    Daniele Hill MSN RN NPD-BC AMB-BC CCCTM
    Emory Healthcare
    Dallas GA
    (443) 878-0910
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    Original Message


  • 5.  RE: Prior Authorization

    Posted 07-06-2024 09:50
    I am so happy for you that you utilize nurses to do the prior authorizations.

    Years ago, I was a nurse doing them.  Currently, I am limited to a medical assistant staff. They are not familiar with medications and even if they know the drug names, they are not familiar with what information should be included with the prior authorization.  The physicians in the practice do not provide any specific education or competencies for the MAs. The MAs although legally supervised by medicine in NJ, are in a supervisory line that under a "billing and coding" manager who answers to the administrative practice manager (non-clinical).  

    Prior authorizations need to have minimal requirement, or they are simply denied. This would make a great research study if one could compare the success of Prior Auth decisions between nursing and MA staff regarding "specialty or high tier medications," and procedures (botox, trigger point injections, joint injections, application of Qutenza for neuropathic pain, etc. 

    I believe some data on this issue would provide an excellent ROI for role of the RN in the ambulatory care practice. 

    ---------------

     

    Aleesa M Mobley PhD APN  (she/her/hers) Why Pronouns Matter

    Assistant Professor - Clerkship Director [Pain Management/Substance Use Disorder]

    Physical Medicine & Rehabilitation - Neuro Musculoskeletal Institute 

    Lippincott Procedures: Subject Matter Expert - Wolters Kluwer Publishing


    Rowan Medicine Bldg., 42 E. Laurel Rd, Ste 1700, Stratford New Jersey 08084 

    T: 856-566-7010 | F: 856-566-6956| C: 856-230-1229 

    mobley@rowan.edu | som.rowan.edu 
    Learning is not attained by chance, it must be sought for with ardor and attended to with diligence [Abigail Adams (1744 - 1818), 1780].



    Original Message


  • 6.  RE: Prior Authorization

    Posted 07-12-2024 10:32
    Edited by Roxanne McCurry 07-12-2024 10:33

    I work for a large teaching hospital, and we also have a dedicated team who complete our prior auths - they are pharmacy techs. However, there is such a high number of requests that it takes them about 4 weeks to complete a routine request. Urgent requests get addressed same or next day.

    Roxanne



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    Roxanne McCurry RN
    UWMC

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    Original Message


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