If your practice runs on eClinicalWorks (eCW), a medication PA might start in the e-prescribing screen, move to the CoverMyMeds portal and get chased by fax, while a procedure PA lives in a different module entirely.

This guide breaks down the five ways eCW practices get PAs done: what each covers, how it works day to day inside eCW, and their limitations. We've previously published the same breakdown for athenahealth and Epic.

Medication PAs vs. Medical PAs in eClinicalWorks

Medication (pharmacy-benefit) PAs cover prescriptions billed to the patient's drug plan: GLP-1s, biologics, ADHD medications and other specialty drugs. In eCW, these run through the e-prescribing workflow, exchanging requests directly with pharmacy benefit managers (PBMs).

Medical-benefit PAs cover procedures, imaging, referrals and physician-administered drugs billed to medical insurance. In eCW, these go through the Service Authorization Request module and your clearinghouse, built around CPT/HCPCS and ICD-10 codes.

The split matters beyond navigation. Payer rules, submission rails and even federal deadlines differ. Since January 1, 2026, CMS-0057-F has required Medicare Advantage, Medicaid and CHIP plans to decide standard medical PAs within 7 calendar days (72 hours if urgent), but CMS notes that none of the rule's policies apply to drug PA decisions.

The 5 Ways to Do Prior Authorizations in eClinicalWorks

Option 1: eCW's Native Medication ePA

Electronic prior authorization is built into eCW's prescribing workflow. When the Surescripts partnership launched in 2015, the company described prescribers being notified as soon as a drug requires PA, with forms prepopulated from its direct PBM connections.

How it works in eCW:

1. The prescriber writes the prescription in eCW, and formulary and benefit data flag drugs that require PA.
   
   

2. The prescriber or staff start the ePA request, with patient, prescriber and medication details prefilled.
   
   

3. The PBM returns a question set specific to the patient's plan and drug. Your team answers it and attaches supporting documentation.
   
   

4. The determination comes back electronically, sometimes before the patient leaves the office.

Best for: Every eCW practice, for every PBM on the electronic network. If prospective ePA isn't part of your prescribing routine, fix that before evaluating any vendor.

Where it stops: Coverage depends on PBM connectivity. Plans without ePA support, specialty drugs that need evidence beyond the question set, denials and appeals all fall back to staff. eCW's CEO has said the company's AI agents take over work like prior authorizations, so ask your eCW representative what's actually available on your version.

Option 2: Service Authorization Requests (Medical-Benefit PAs)

For procedures, imaging and referrals, the Service Authorization Request module is eCW's native path. It also comes with the two tools eCW practices rely on to fulfill PAs: Jelly Bean notifications and the Authorization Tracker.

How it works in eCW:

1. Open the patient's chart, go to the Billing tab (or the billing section of the encounter) and create a Service Authorization Request.
   
   

2. Enter CPT/HCPCS and ICD-10 codes, the requesting provider's NPI, service dates and units.
   
   

3. Attach progress notes, imaging or lab results and any letter of medical necessity.
   
   

4. Submit electronically through TriZetto Provider Solutions or your configured clearinghouse, or by fax for payers that don't accept electronic requests.

Route every PA status change to a Jelly Bean with an owner, and agree practice-wide on what each color means. Then review Reports > Authorization Tracker weekly for requests that are pending past the payer's deadline, denied without an appeal or about to expire.

Best for: Practices with meaningful procedure, imaging or infusion volume. TriZetto's eClinicalWorks integration adds automated eligibility checks and an automated prior authorization option it says can cut approvals to minutes.

Where it stops: It doesn't handle prescriptions billed to a drug plan. And the module transmits and tracks requests; it doesn't build the clinical case. Staff still assemble the packet for every submission.

Option 3: Portals and Fax Outside eCW

A lot of eCW PA work happens outside eCW. Pharmacy-initiated requests, plans without ePA support and payer-specific portals all pull staff into another browser tab. The most common is CoverMyMeds, which is provided at no cost to care teams and works for all drugs and health plans. Whether it's available inside your eCW workflow isn't clearly documented, so many eCW teams simply work it through the web portal.

How it works:

1. Log in to the portal and start or open the request. Pharmacy-initiated PAs appear in your CoverMyMeds dashboard.
   
   

2. Re-enter patient and drug details, answer the plan's questions and upload notes exported from eCW.
   
   

3. Check back for the determination, then attach it to the patient's chart in eCW and close out the Jelly Bean.

Best for: Covering plans and requests native ePA misses. It costs nothing and reaches nearly every PBM.

Where it stops: Double data entry, and status that lives outside the chart. This swivel-chair work is where PAs tend to go missing, and where much of those 13 weekly hours go.

Option 4: Outsourced PA Staff Working Inside eCW

Billing companies and virtual-assistant firms offer remote PA specialists who get their own eCW logins and work the same tools your team does: Service Authorization Requests, Jelly Beans, payer portals and phone follow-ups. For practices that would otherwise join the 40% of physicians with dedicated PA staff, it's the main alternative to hiring.

Best for: Practices with high medical-benefit volume that can't hire fast enough, or that need coverage for backlog spikes.

Where it stops: It moves the work rather than removing it. Cost scales with volume, quality depends on the specific team, and you're still managing a manual process, now with a vendor in the middle.

Option 5: AI Automation on Top of eCW (Develop Health)

Develop Health automates the full pharmacy-benefit PA cycle: 

• benefit verification
  
  

• payer form identification
  
  

• clinical evidence extraction with citations
  
  

• submission
  
  

• determination follow-up
  
  

• denial analysis and appeal letters.

For eClinicalWorks, Develop Health connects through an RPA-based integration. This means that our software works inside eCW the way a trained staff member would, so there's no interface build for your IT team. Organizations with engineering resources can also use the Develop Health API to run benefit verifications and submit PAs, with webhooks pushing status changes as they happen. Either way, providers keep prescribing in eCW exactly as they do today.

What it adds beyond options one to four:

• Benefit verification before the pharmacy rejection: Develop Health automatically picks the available verification route for each patient's plan. 80% of successful real-time checks finish within 10 seconds, with AI-assisted calls (typically 30-60 minutes) and human calls as fallbacks.
  
  

• Evidence-backed form completion: AI pulls supporting clinicals from historical notes and labs, then fills payer question sets with cited documentation. This is the step that consumes most staff time and drives most denials.
  
  

• Your choice of control: In a delegated workflow, Develop Health prepares, submits and follows up on its own. In a non-delegated workflow, your reviewer checks the prefilled answers and evidence and approves before anything reaches the payer.
  
  

• Coverage beyond the ePA rails: ePA where it exists, AI phone calls and fax where it doesn't, with human fallback.
  
  

• The back half of the process: Determination chasing, denial-reason analysis and AI-generated appeals, which none of the other options automate.

Customers have seen a 14% lift in approval rates and prescription-to-approval times cut from roughly 1.5 weeks to about 20 hours. Arches Primary Care processed roughly 800 PAs in its first six weeks, cutting turnaround from weeks to two days and saving 20–30 staff hours per week.

Best for: Organizations on eCW with high pharmacy-benefit volume in specialty medications: GLP-1s, biologics, specialty neurology. Also, it’s the only option on this list that automates appeals.

Where it stops: Pharmacy-benefit only. For procedure and imaging authorizations, use options 2 and 4.

Side-by-Side: PA Options in eClinicalWorks

Automate the PAs eClinicalWorks Can't

eCW's native ePA and Service Authorization Requests should be your baseline. Turn on prospective ePA, configure Jelly Beans and review the Authorization Tracker every week. But the work that burns the most staff hours sits outside what those tools automate: evidence gathering for specialty drugs, portal and fax requests for non-connected plans, denial chasing and appeals.

Develop Health handles that complete pharmacy-benefit cycle alongside your eCW workflow, with no change to how providers prescribe. Book a demo to see how it fits your practice.

Frequently Asked Questions

How do I submit a prior authorization in eCW?

It depends on the request. Medication PAs start in the e-prescribing workflow through ePA when the patient's PBM supports it, or through CoverMyMeds and payer portals when it doesn't. Procedure, imaging and referral PAs go through the Service Authorization Request module under the patient's Billing tab, submitted through your clearinghouse or by fax.

How do I track prior authorizations in eClinicalWorks?

Use Jelly Bean notifications to route each PA status change to an owner, and Reports > Authorization Tracker for a practice-wide view of pending, approved, denied and expiring authorizations. PAs worked in outside portals only appear there if someone logs them back into eCW.

Does CoverMyMeds integrate with eClinicalWorks?

It isn't clearly documented. CoverMyMeds' current site doesn't publish an EHR-by-EHR integration list, so confirm availability in your eCW setup with your eCW representative. Either way, the free CoverMyMeds web portal works alongside eCW.

Does the CMS 7-day prior authorization rule apply to medications?

No. CMS-0057-F's 7-day standard and 72-hour expedited decision windows apply to medical items and services, not drugs. In April 2026, CMS proposed extending electronic PA and decision timeframes to drugs in CMS-0062-P, but that rule isn't final.

How long does a medication PA take in eCW?

It ranges from minutes to weeks. ePA requests to connected PBMs can come back while the patient is still in the office, while manually worked PAs through portals and fax often take one to two weeks. End-to-end automation platforms have cut the full prescription-to-approval cycle to about 20 hours.

Can AI prior authorization tools connect to eClinicalWorks?

Yes. Third-party tools typically connect through RPA, which works inside eCW the way staff do, or through APIs, and eCW introduced an AI API Workbench for custom AI agents at HIMSS26. Develop Health uses an RPA-based integration for eCW, with its API available for organizations that want to build their own connection.