PA Logic

End to End Prior Authorization Workflow Platform

Best Practice Capabilities

  • Efficient and transparent processes

  • Industry regulations and standards compliance

  • Greater managerial insight 

  • Detailed case auditing information

  • Actionable program and plan-by-plan reports

  • Maximum flexibility to meet complex plan and program hierarchy configurations

PA Logic includes these features: 

Member & Drug Driven Clinical Criteria Presentation

Ensures appropriateness and quality (right drug, right dose, right quantity, and correct frequency)

Audit Trail

Viewable audit trail that tracks request changes by user, date, and timestamp 

Integrated Drug Lists Management

Drives business rules associated with formulary rules specific to a member’s benefit. Examples include: step therapy, quantity limits, or PA required

Integrated Fax Management

Attaches faxes to PA requests and creates efficiencies for sorting, labeling, and time stamping all incoming requests and notifications

Intervention

Pushes providers to the preferred formulary and alternative agents and collects required information to quantify the value to your customers

Appeals Processing

Appeals reviewers can view a consolidated and complete record including all notes, documentation, criteria review, and other relevant data.

Outbound Call Documentation

Outbound call codes and notes available for reports.   

Notifications

Faxed/printed notifications generated at regulatory mandated steps within the workflow.  

Request History

Search by member/patient, physician, or request ID for a detailed record of all requests containing notes, viewable fax images, and inbound and outbound documentation and notifications. 

Reports

Wide array of on-demand standard and ad-hoc reporting capabilities. 

Integration with PBMs

SFTP connection for secure submission of batch files. Optional Manual upload to PBM claim system by PA Logic Solutions or client staff is available.

Use our PA Service Center

While some PBM clients license PA Logic for use by their internal review teams, PA Logic Solutions has a fully-staffed PA Call Center to provide review services from intake to notification or as a supplement to the client’s review team.

Our PA Call Center is staffed by technical and clinical support specialists who consistently provide top quality customer service to our PA clients and their customers. Our team adjudicated over 620,000 requests in 2018. PA Logic Solutions trains all personnel in the particulars of each client’s policies and procedures to maximize workflow efficiency and to ensure service specific to each client’s needs.

PA Logic Solutions has a fully-staffed PA Call Center to provide review services from intake to notification or as a supplement to the client’s review team. Our PA Call Center is staffed by technical and clinical support specialists who consistently provide top quality customer service to our PA clients and their customers.  

Our Call Center team consists of clinical personnel, including pharmacists, nationally certified pharmacy technicians (CPhT), and administrative personnel providing high-quality service to clients and their member and provider communities.

Our PA Call Center operational teams have a mixture of skill sets to ensure the appropriate level personnel perform each function at the right time in the coverage determination process. Personnel are trained continuously on clinical topics, administrative and operational subjects, and security policies and procedures, such as HIPAA regulations.

States Contain PA Logic Clients

%

(Up to) Reduction in Pharmacy Spend

%

Avg. System Uptime (Annualized)

Years of Experience Providing Services

MILLION Lives Provided PA Services

Want to schedule a demo?

Get in touch with us today. 

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