Does the platform support real-time electronic prior authorization (ePA)?
Yes. Ethermed supports real-time ePA via eFax, payer portals, and increasingly through payer APIs mandated by CMS-0057-F (CMS Interoperability and Prior Authorization final rule). In many payer relationships, this process has contributed to significantly faster turnaround times, with clients often seeing up to a 50% reduction.
How does Ethermed handle specialty drug prior authorization workflows?
Ethermed manages many complex specialty drug workflows, which vary by drug and payer. For many of the more common specialty drugs and payers, our dynamic form logic adapts to meet multi-step (“step edit”) and payer-specific requirements.
Does Ethermed offer appeals management?
Yes. Ethermed supports re-submission, automated appeal generation, peer-to-peer review summaries, denial defense letters, and payer-specific templates. These workflows are designed to minimize manual intervention and speed resolution.
How does Ethermed answer questions on payer websites before an authorization number is assigned?
Ethermed automates this step through direct payer portal integration and policy-trained AI. In many cases, we can retrieve payer-specific question sets and pre-fill them using patient demographics, clinical data, and codes from connected EHRs and document repositories. Our AI is trained on over 100,000 policies across 168 payers, making it typically accurate in completing requirements before an authorization number is issued.
