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Submit pharmacy prior authorization requests using new eForm
February 6, 2017

You can now electronically request medication authorization for commercial members

When a medication requires prior authorization, you can now submit the Massachusetts Standard Form for Medication Prior Authorization Requests electronically with our new eForm. Enter information about your request directly into the form, hit the “submit” button, and your request is sent right to us. The eForm replaces the PDF version of the form.

The form is now standard for Massachusetts health insurers to meet the requirements of Chapter 224. It was developed with the Mass Collaborative, a partnership of payers, providers, and trade associations. We expect additional all-payer medication authorization forms to be made available in the future, and will let you know.

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There are two ways to find the eForm
  • Go to the Forms section of our website. Make sure to look in Authorization-Pharmacy.
  • Look in the medical policy (if the medication has a medical policy).
When to use the eForm

Use it:

  • For members who have a commercial HMO or PPO prescription plan with us.
    (For all other members, such as Federal Employee Program and Medicare Advantage members, use the same process you use today to request medication authorization.)
  • To request prior authorization for prescription medications and medications you administer in your office (pharmacy and medical benefits).
    Remember: It’s used only for medications that require prior authorization. You can use our medication look-up tools to see if a medication requires prior authorization.
Getting started
  • Have all the information you need ready. This includes the member’s information, including their Blue Cross Blue Shield of Massachusetts ID card, and information about the prescribed medication.

    Important:  You’ll need to allow enough time to fill out the form entirely since you cannot save it to fill out later.

  • Use a supported browser. Internet Explorer 7, 8, 9, or Firefox work best. You may not be able to open or submit the form if you use another browser.

    Internet Explorer 8.0 users. Select “No” when you see a pop-up box that says, “Stop running this script” so you can continue with your submission.

  • Fill out the eForm completely. We make authorization decisions based on the clinical information you submit to us.
Instructions for using the eForm

There are three separate screens you’ll need to fill out:

  • Screen 1: Enter patient, prescriber, and medication information
  • Screen 2: Add clinical information to support your request
  • Screen 3: Signature

Tips

  • When entering the member ID on the first screen, enter the letters (prefix) and the 9-digit numbers on the member’s Blue Cross Blue Shield of Massachusetts ID card. The system will give the user an error message if this is not entered correctly.

    Important: Use your usual process for Medicare Advantage and Federal Employee Program members. The system will not accept the “R” prefix with numbers for Federal Employee Program. It only accepts 3 letters with the 9 digits.

  • On the Signature page (see example), be sure to enter the name of the prescribing clinician or authorized representative, then press “Enter” on your keyboard. (If you don’t type enter, you won’t be able to press the Click to sign button.)

  • If you’ve already completed the Signature page and you need to go back to correct something you entered on a previous screen, please be sure to “un-sign” the Signature page. This is very important because you won’t be able to make your correction without removing all of your information on this Signature page.  Here’s how:
    1. Click the "ACCEPTED" button
    2. In the Signature Information pop-up window, choose “Delete”
    3. Then click "OK"
    4. Delete the name in the “Prescribing clinician or authorized representative” field
    5. You’ll get a pop-up box with an error message
    6. Click "OK"
    7. Click the “Previous” button
    8. Go back, make your change, then re-sign the form
  • When you successfully submit the eForm, you’ll get a message that we are reviewing your request. We’ll reply by fax.
Frequently asked questions
Q: Do I have to use the electronic version of the standard form, or can I continue to use the forms I currently have on my desktop for Blue Cross members?
A: You should replace any forms you currently have on file and start using the electronic version of the Massachusetts Standard Form for Medication Prior Authorization Requests.
 
Q: Can I continue to call in authorization requests by phone?
A: Yes, if you prefer calling in your prior authorization requests, you can continue to call our Clinical Pharmacy Operations area at 1-800-366-7778.
 
Q: Should I use the eForm if we’re buying and billing a medication and the medication has a prior authorization requirement?
A: Yes, if the medication requires prior authorization, please use the eForm for medications that you administer and bill us for using the member’s medical benefits.
 
Q: What if I have an urgent request?
A: Make sure to check the “Expedited Review/Urgent Request” box and we will expedite your request.

 
Q: Can I submit attachments to help support my request?
A: Yes, you can. You’ll be prompted to upload any attachments. We accept files up to 5 MB in these formats: Pdf, doc, docx, xls, xlsx, csv, txt, bmp, gif, jpg/jpeg, png, and tiff.
Q: Do I need to fill out everything on the eForm?
A: It’s very important that you fill out all required fields on the eForm and supply us with any relevant clinical information. We make authorization decisions based on the clinical information you submit on your form. Your request could be denied if we don’t have enough information.
 
Q: What do I do if my authorization request is denied?
A: If we deny your authorization request, we’ll notify you. The letter that we fax to you will include information on what to do to appeal our decision. We don’t send these notifications by email.
 
Q: Why can’t I open the eForm?
A: You may not be able to open or submit the eForm if you use a browser that’s not compatible. Internet Explorer 7, 8, 9, or Firefox work best.
  Here’s what you might see if you aren’t using a supported browser (Internet Explorer 11 was used in this example.)

 
Q: How do I know what browser version I’m using?
A: Usually you can find out what version of your browser you’re using by checking under the “Help” section of your browser and look for “About.” If you need to download a different version, check your browser’s website for instructions.
 
Q: I’m trying to sign the eForm, but the “Click to sign” button isn’t working. What’s wrong?
A: When you enter the name of the prescribing clinician or authorized representative, you need to make sure you type “Enter” on your keyboard (or hit the “Tab” button on your keyboard). Then, you should be able to hit the “Click to sign” button.

 
Q: I want to make a change, but I already signed the eForm and it won’t let me make the change. What should I do?
A: If you’ve already signed the eForm, you need to un-sign it before you can make a change. To do this:
  1. Click the "ACCEPTED" button
  2. In the Signature Information pop-up window, choose “Delete”
  3. Then click "OK"
  4. Delete the name in the “Prescribing clinician or authorized representative” field
  5. You’ll get a pop-up box with an error message
  6. Click "OK"
  7. Click the “Previous” button
  8. Go back, make your change, then re-sign the form

 
More questions?

If you have questions, contact Clinical Pharmacy Operations at 1-800-366-7778.

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