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Frequently Asked Questions

General

CoverMyMeds allows healthcare professionals to find, fill out, and submit prior authorization (PA) requests for all drugs. CoverMyMeds provides instant access to PA requests for all Medicare Part D plans, Medicaid plans, and virtually all Commercial plans.

Pharmacies use CoverMyMeds to quickly find the right request and share it with the provider for completion.

Providers use CoverMyMeds to complete requests already started by a pharmacy or to start a request themselves. PA requests can be completed online and submitted to the plan with the provider’s digital signature.

CoverMyMeds is the only source needed to submit prior authorization (PA) requests for all drugs and virtually all healthcare plans. The overall benefit of using CoverMyMeds is to help your patients get their prescribed drugs. By using CoverMyMeds, you can also save time and ease frustration with the PA process.

Benefits for Providers:

  • Office information can be auto-filled so you don’t have to re-type it on every request.
  • The provider can sign electronically and the signature is stored for future use.
  • Any request a pharmacy starts through CoverMyMeds for one of your verified providers will automatically show up on your dashboard.
  • Receive faster determinations – often within hours – from plans that work with CoverMyMeds to offer electronic Prior Authorization.

Benefits for Pharmacies:

  • Simplify the PA process by only entering the patient’s name and date of birth to initiate a PA request.
  • Reduce prescription abandonment by providing providers with the right PA request, making it more likely they will complete the request.
  • We integrate with many pharmacy systems, which allows you to start a request from your existing software!

We work hard to take every step necessary to protect health-related data. All information transferred to and from CoverMyMeds is encrypted through SSL (Secure Sockets Layer) technology, up to and above the industry standard. Our servers are managed securely and backed up properly, among other safeguards. Our Terms of Service comply with insurance plan rules, as well as Medicare, Medicaid, and HIPAA guidelines.

Your demographic and patient information is protected by our Privacy Policy and only used to help you complete PA requests for your patients. Individually identifying patient data is not shared with any other party, including our clients.

We work hard to ensure CoverMyMeds remains free for healthcare providers by partnering with health plans, PBMs, and select pharmaceutical companies who pay for the service. These organizations support free use for providers because they benefit from providers using the system and the improved efficiency of the process.

CoverMyMeds specifically focuses on prior authorization assistance for patients with prescription drug coverage. If you have a patient that does not have insurance for their medications, you may want to contact The Partnership for Prescription Drug Assistance via the web at PPARX.org or by phone at 1-888-4PPA-NOW (1-888-477-2669) or another payment assistance program.

Some states do require the use of electronic prior authorization (ePA), or outline it as an option providers can leverage to lessen the burden of prior authorization (PA). CoverMyMeds may be used to comply with all ePA legislation.

In addition to states that require ePA today, many have pending legislation, making it a good idea for providers and their staff to begin using an electronic submission method.

CoverMyMeds closely tracks ePA legislation. Visit our ePA legislation map to find out if ePA is required in your state.

As of 12/15/15, CoverMyMeds will support the following browsers:

  • Google Chrome
  • FireFox 3.5 or later
  • Internet Explorer 7.0 or later
  • Safari 3.0 or later

On 12/15/15 we will discontinue support for Internet Explorer 6 in order to meet the latest security requirements. If you’re using Internet Explorer 6, please update your browser at no cost to continue using CoverMyMeds.


No. CoverMyMeds is web based, and does not require any additional software on your computer.

Prior Authorization

Pharmacies

If you have a BIN, PCN, and Group, which can usually be obtained from the patient’s prescription insurance card, type that in the “Search terms” field on the “Find the form you need” page to find plan requests that match that information.

Providers

Providers search by typing the name of the patient’s prescription insurance plan in the “Plan, PBM,…” field on the “Find the form you need” page. The plan name may be on the patient’s prescription insurance card or on the rejection fax received from the pharmacy. These sources may contain a BIN and PCN, which you can also search by.

If the pharmacy sends a rejection fax with a phone number to call for authorization, you can call that number to listen to what plan answers or enter the number in a search engine (such as Google) to see what plan it matches.

Tip

If the patient has Medicare, you can call 800-MEDICARE (800-633-4227) and ask for “drug coverage.” You will need the patient’s Medicare ID number and date of birth. The automated system can usually give you the plan name within a minute or two, without having to wait to speak to a person.

Follow these steps on the “Find the form you need” page.

  1. Verify the “State,” which defaults to where you are located. If your patient has a state-specific insurance plan from a different state, you can click to change it. (This applies to plans such as BCBS or Medicaid.)
  1. Start typing the name of the patient’s “Medication” and choose the strength you need from the dropdown menu.
  1. Enter the patient’s plan information by typing the prescription insurance name or BIN and PCN found on the patient’s insurance card.
    • You can refine your search by entering multiple words (e.g. Aetna Medicare, Humana Hospice, etc.)
  1. CoverMyMeds will present you with the request(s) that match your search criteria. If there is more than one option, select the one that best suits the circumstance.
    • You can click on “More info” to see details on when to choose a particular request form. Click “+ Show more forms” to see additional form options

If the fax is successful, a fax successful note is added to the PA request under Notes. You may need to click “All” or “Older” at the bottom of the “Notes” panel to view all of the notes for that request. If your fax fails, a failure notification is sent to the email address associated with your user account. (Some pharmacies may receive this by fax instead of email.) A fax failure note is also added to left column of that prior authorization (PA) in the Notes under the action buttons.

The plan will alert the provider’s office by fax when a prior authorization (PA) request is approved. The plan will typically notify them using the fax number on the submitted PA. For electronic PA requests, you may also receive a determination directly through CoverMyMeds. On average, it takes between 1 and 5 business days for the plan to come to a determination.

It is typically up to the provider to let the pharmacy know when they can fill the prescription. Pharmacies can request to be notified of PA determinations by updating their preferences in CoverMyMeds. While this is not a guarantee that the plan will notify the pharmacy, it does add the pharmacy’s contact information and notification request to the PA.

Archiving is beneficial because it provides an easy way to organize your prior authorization (PA) requests keeping only current requests on your “Dashboard.” When you archive a request, it is removed from your dashboard and an email update is sent to all other users with access to the request, saving you a phone call.

Providers

You should archive a PA request when the plan has notified you of an approval or denial.

Pharmacies

You should archive a PA request when the provider’s office has notified you of an approval or denial, or when the related claim has been successfully adjudicated.

If you need to access an archived PA request, go to the “Search” tab on your “Dashboard” and search for the archived request by the patient’s first name, the patient’s last name, your identifier, the key, the drug, or the plan name.

Once archived, the request becomes inactive and cannot be edited or sent.

The “Renew” button allows you to quickly create a new prior authorization (PA) request using imported information from an existing request, making sure you have the most up-to-date request without having to start over.

To use the Renew feature, follow the steps below:

  1. Open the request you’d like to renew and click “Renew” in the left panel. If renewing an open request, click “More Options” to reveal the “Renew” button. If renewing an archived request, “Renew” will be visible in the left panel.
  1. A pop-up box will appear with the patient, request form name, and drug information for you to confirm. When you are ready to renew the request, click “Create Renewal.”
  1. After the new request appears, review each section and update information when needed. Click the blue boxes along the right side of the request to confirm you’ve done this.
  1. Once each box has been checked, click “Send to Plan” to complete your submission.
Yes. In conjunction with the health care industry, CoverMyMeds is converting to ICD-10 as of Oct. 1, 2015. Providers and pharmacists will be prompted to select an ICD-10 code if they enter an ICD-9 code on a PA request. This ensures your PA requests are compliant and as accurate as possible.
ICD-9 codes identify a diagnosis with only three to fivenumbers, but this format is running out of combinations. ICD-10 combines alphanumeric and numeric formats and creates nearly 60,000 more diagnosis codes. The ICD-10 coding system defines existing and new diagnoses, but with a more efficient structure.

Provider

To log into your CoverMyMeds account, scroll to the top of this page and enter your username and password in the associated boxes in the gray bar, then click the button labeled “Log in.” You can also visit and bookmark the log in page.

The process for creating an account is the same whether you complete prior authorization (PA) requests for one provider or many.

You can verify all of the providers you work with via the “Prescribers” link at the top of the page after creating your account. You’ll search for your providers by name or NPI, choose a fax number, and once they’ve all been added, click “Initiate Verification.”

When filling out PA requests, the provider information you enter will be automatically saved for use on future requests. The address book is located just above the “Prescriber Details” section on the PA requests.

If there are multiple people in your offices who will be filling out prior authorization requests for the same providers, we can set up a group so you’ll have separate logins but still see the same information. If you would like to get set up in a group, create a username and password for the group administrator, then contact us at 1-866-452-5017.

For many provider offices and pharmacies, the prior authorization (PA) process is a team effort. One way for users to collaborate on PA requests is by working together in a group account. This is recommended because everyone in the group will be able to see and work on the same requests while having their own username and password. Group members can be added or removed at any time by the group administrator.

If you would like to get set up in a group, create a username and password for the group administrator, then contact us at 1-866-452-5017 or chat using the live chat box in the bottom right corner of the screen.

View our Group User Guide

After you’ve completed the prior authorization (PA) request, click “Send to Plan” in the left panel. Scroll down to the bottom of the screen and locate the white signature box with an X and dashes inside it. Click and hold down your mouse’s left button while moving the mouse like a pen to sign. If you’re unhappy with your signature, click “Reset” below the box and start again. When you’re satisfied, click “Fax.” This will send the PA request to the plan and store the signature in your account for future use.

Some requests are completely electronic, and therefore will not have a fax page. If those need a signature, the signature box will be visible on the screen when filling out the request.

CoverMyMeds integrates with a variety of EHRs, with more being added frequently. If you know your EHR already integrates with CoverMyMeds, just click the chat box in the bottom right corner of the screen and we’ll be happy to help. To check to see if your EHR is integrated or to request an integration, click here.

CoverMyMeds allows you to attach .pdf, .jpg, and .tif files to many prior authorization (PA) requests, and some plans require lab results or other documentation. If the records you’d like to attach are in your EMR or EHR, you’ll first need to save them as one of those supported file types in order to attach them.

How you can save patient records will vary by EHR vendor. Many offer a “Print to PDF” option after you click print in your EHR system. You may need to change the printer destination or add a printer on the print screen to see this. If you’re not sure how to do this in your system, we recommend checking with your IT department to see what options are available.

Pharmacy

When starting a prior authorization (PA) request through your pharmacy system or network, CoverMyMeds automatically chooses a request when we’re able to identify one specific request that matches the rejection data. This happens roughly 80% of the time. If you need a different request, click on the “Choose new form” button under “Other Actions” in the left panel. Enter new search terms for the request you need such as the BIN, PCN, or name of the PBM or plan. Select the new request and the information entered on the original request will carry over.

To select a new medication or strength, start a PA request from a new claim.

CoverMyMeds integrates with a variety of pharmacy systems. We offer an EasyButton solution to start a prior authorization (PA) request for you with information from your pharmacy system in just a single click. Then, you can login to CoverMyMeds to follow up on or manage all of your PA requests.

Individual instructions for each system we integrate with are available on our “Pharmacy Systems” page.

PriorAuthPlus is a free service that allows you to start a prior authorization (PA) request in CoverMyMeds for any medication and any prescription insurance plan by submitting a claim through your RelayHealth network. Our system picks a PA request specific to the patient’s drug and drug plan based on the claim rejection information, then you can send it to the provider to complete. To sign up, please contact your RelayHealth representative to turn on the feature.

Once signed up, you will receive notices in your pharmacy system, to start a request for certain medications, but you can use this service for any rejection with a 70, 75, or 76 rejection code.

Resubmit the rejected claim through PriorAuthPlus with the process listed in your Pharmacy Reference Guide. An augmented rejection message will come back reading, “Prior Authorization (PA) initiated for this compound. Log in to CoverMyMeds.com and enter the active ingredients under the Additional Questions.”

In the CoverMyMeds website, find the PA request on your dashboard. Open it and confirm the PA request selection. The medication at the top will be listed as “Compound Drug.” Scroll down to “Additional Questions” and specify the name, strength, and quantity of each active ingredient of the compound drug. Then, submit the request to the provider for completion using the “Send to Prescriber” button.