What is CoverMyMeds?
CoverMyMeds (CMM) is a website that enables providers, pharmacists and their staff to complete and submit prior authorizations (PA) requests electronically.
Why do we use CoverMyMeds?
CMM streamlines the medication PA process, electronically connecting providers, pharmacists and third party plans (prescription medication insurance). CMM may shorten the turn around time of an approved prior authorization, which will improve time to therapy and decrease prescription abandonment with electronic prior authorization (ePA).
Is CMM HIPAA compliant?
CoverMyMeds has established technical, physical and administrative safeguards to comply with the HIPAA Privacy and Security Rules and implementing regulations. Many of the largest health care organizations in the U.S. have audited CMM’s compliance and found it to be satisfactory.
In addition, CoverMyMeds maintains a business associate agreement (BAA) with SCH as required by HIPAA.
Change in practice
Our experienced billing technicians have been submitting PA requests through CMM for several years already, but starting July 2nd, they will begin submitting a majority of PAs directly to the third party plan rather thansubmitting them to prescribers. Providers/clinics will only be notified when the insurance company is requiring more clinical information that the technician cannot provide, which is rare.
Impact on prescribers
Prescribers and clinics should experience a reduction in CMM workload requests from SCH outpatient pharmacies. However, if one of our pharmacies does contact you regarding CMM, please try to have someone in the clinic reply within 24 hours as the prior authorization(s) could time out and thus need to be reprocessed from the beginning. The current process will remain unchanged for prescriptions sent to external retail pharmacies as prescribers will still need to process/respond to PA requests accordingly.
Please contact Meridith Dandridge in Outpatient Pharmacy with questions.
EXAMPLE: Prior Authorization Request from CoverMyMeds