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Prior Authorizations

ExpressPAth offers Easy Online Prior Authorization across Both Pharmacy and Medical Benefits 

ExpressPAth is an innovative, web-based tool that enables physicians and other healthcare providers to submit, renew and appeal prior authorization requests online. Providers can also check patient eligibility and benefits in real time. ExpressPAth ensures patients receive their medications faster and providers spend less time phoning and faxing the health plan.

How it Works

Physicians and other providers can register online to use ExpressPAth. Once registered, providers use ExpressPAth to seamlessly submit and manage prior authorization requests across the medical and pharmacy benefits.

  • ExpressPAth is available to providers and their designated agents, such as nurses and non-clinical office staff.
  • The easy step-by-step process includes instructional text and “help” guides.
  • E-mail notification is sent when a decision is made or status changes on a request.
  • ExpressPAth provides real-time status of all prior authorizations.

Benefits

ExpressPAth offers many benefits to healthcare providers and patients:

  • Reduced administrative demands – office staff spends less time on the phone or faxing paperwork for prior authorizations.
  • Single platform for all prior authorizations – providers can manage prior authorizations across pharmacy and medical benefits.
  • Online benefits check – providers can check patient eligibility and benefits online, allowing the patient to get the right medication at the right cost.
  • Real-time approvals – occurring in approximately 85% of cases, real-time approvals are available when a health plan’s clinical criteria requirements are met, enabling patients to get their medication faster.
  • Review of about-to-expire prior authorizations – providers can proactively renew prior authorizations up to 90 days before expiration, avoiding potential lapses in patient therapy.
  • Online appeals – up to five levels of prior authorization appeals can be managed online.
 

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