AmeriHealth actively studies member satisfaction to enhance the health and well-being of the people and communities we serve. Analyses related to the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey along with other member experience metrics show a positive correlation between member satisfaction and efficient processing of prescription drug prior authorization requests. Members report frustration with delays in decisions caused by incomplete coverage determination forms.

Our findings

Through our analyses, we have found that members calling to inquire about the status of their coverage determination would often find that the process was delayed due to missing information. 

Examples of missing information include: diagnosis codes, lab values, and medication history details (e.g., trial and failure of formulary medications).

Steps to take

AmeriHealth will make several attempts to contact the provider to obtain missing information.  There are scenarios where the provider’s office is unavailable, such as weekends and holidays, which may result in a denied coverage determination, member inconvenience, and the potential need to initiate an appeal.

We strongly encourage providers to:

• Empower their office staff and on-call services to support health plan outreach.
• Complete all coverage determination forms carefully and thoroughly to minimize the need for follow-up from AmeriHealth.
• Use our electronic prior authorization (ePA) platform through CoverMyMeds^® or SureScripts^TM.

Using ePA enables providers to receive real-time prior authorization decisions. The decisions are based on an algorithm created for approximately 100 of the most-requested medications from all drug classes that require prior authorization under an AmeriHealth formulary.

For more information

A more detailed article on the annual CAHPS survey will be published next month.

If you have any questions about registering or using the portal, call CoverMyMeds at 1-866-452-5017 or SureScripts at 1-866-797-3239. If you have any questions about ePA, call FutureScripts^®, our pharmacy benefits manager, at 1-888-678-7012.