Prior authorization in Elation EHR became easier in July 2025, when Elation launched native electronic prior authorization (ePA) for prescriptions. Prescribers can now start a PA from the Prescription Form and track it in a central ePA Worklist, instead of waiting on pharmacy faxes.
That's a significant upgrade, but it doesn't cover every PA a primary care practice handles and the workload remains heavy. The 2025 AMA Prior Authorization Physician Survey found physicians complete an average of 40 prior authorizations per week, consuming 13 hours of physician and staff time. And 95% of physicians say prior authorization delays access to necessary care.
This guide breaks down the four ways Elation practices get PAs done today: what each covers, where each stops, and how to combine them.
Key Takeaways |
|---|
|
The 4 Ways to Do Prior Authorizations in Elation
Option 1: Elation's Native ePA
Elation's electronic prior authorization lets prescribers and their Prescription Delegates send PA requests to the patient's PBM straight from the Prescription Form. Requests then live in the ePA Worklist (Reports → ePA Worklist), where staff answer payer questions, track status and act on determinations.
It pairs with Elation's Surescripts Real-Time Prescription Benefit check, which shows coverage, PA requirements, lower-cost alternatives and out-of-pocket estimates while you prescribe. That's your cue that a PA is needed before the patient leaves.
Here’s how to submit an ePA in Elation:
Open the Prescription Form and confirm active prescription coverage in the right-hand panel.
Enter the medication details: drug, sig, quantity and pharmacy.
Select "Initiate ePA" (or "Initiate urgent ePA") in the Electronic Prior Authorization field.
Click "Save as Draft & Close" to wait for approval, or "Prescribe" to send the eRx now.
Complete the PBM's questions when the Worklist shows "Complete Prior Auth Criteria," attach supporting PDFs and submit.
If you forgot to initiate the ePA before sending the eRx, create a new prescription draft for the same medication, initiate the ePA from it, then discard the draft.
Best for: Every Elation practice that prescribes PA-heavy medications. If you aren't initiating ePAs from the Prescription Form yet, start there.
Where it stops: Elation's own help center FAQ lists the gaps:
Manual initiation: Elation can't automatically request a PA when the formulary requires one, and only prescribers and their delegates can start one.
PBM coverage: ePA works only when the patient's PBM supports it through Surescripts.
Evidence by hand: chart notes and labs must be saved as PDFs and uploaded; there's no direct attachment from the chart.
Limited appeals: electronic appeals work only for PBMs that support them. For the rest, staff contact the PBM directly.
Prescriptions only: referrals, imaging and procedures fall outside ePA.
Option 2: CoverMyMeds (Pharmacy-Initiated and Off-Network PAs)
CoverMyMeds is the ePA portal most pharmacies already use. When a pharmacy hits a PA rejection, it starts a request that reaches your office as a fax key or, once your prescribers are verified, directly in your CoverMyMeds dashboard. It's free for prescribers and their staff, and it works for any medication and all plans, including Medicare Part D and Medicaid.
For Elation practices, it's a practical backstop for PBMs that don't support Surescripts ePA and for requests pharmacies start before you do. CoverMyMeds' own research found patients access medications 13.2 days sooner on average when PAs begin at the provider's office instead of after a pharmacy rejection.
Best for: Catching pharmacy-initiated requests and PBMs outside Elation's ePA coverage, at no cost.
Where it stops: CoverMyMeds runs in a separate portal, and a PA started there doesn't appear in Elation's ePA Worklist. Status lives in two places, and staff re-enter patient details for requests they start in CoverMyMeds. It's also only a transmission layer, not automation. Your team still answers questions, attaches evidence, chases determinations and works denials.
Option 3: Payer Portals and Fax, Tracked in Elation Billing (Medical-Benefit PAs)
For referrals, imaging and procedures, Elation's ePA doesn't apply. Staff submit these the usual way, on each payer's portal or by fax. Elation's job is keep records, making sure the approval follows the patient through scheduling and billing.
Three Elation features help:
Authorization records: In Elation Billing, the Auth button in the patient's insurance box stores the payer, auth number, units and validity dates.
Claim attachment: Staff attach the authorization to the superbill so the number lands on the claim, avoiding auth-related denials.
Auth info at scheduling: Since May 2026, staff can enter PA details when booking an appointment, and they sync to the billing note and claim automatically.
On the payer side, the CMS-0057-F rule has required Medicare Advantage, Medicaid and CHIP plans to decide medical PAs within 72 hours (urgent) or 7 calendar days (standard) since January 2026. The rule excludes drugs entirely, which is one reason prescription PAs remain a separate problem.
Best for: Practices with modest referral and imaging volume that mainly need approvals to stick to claims.
Where it stops: Every submission, follow-up and denial is still manual, one payer portal at a time. Elation stores the result; it doesn't obtain it.
Option 4: AI-Native Automation via API (Develop Health)
Develop Health is an AI platform that automates the full pharmacy-benefit PA cycle, from benefit verification through appeals.
There's no off-the-shelf Elation connector. Instead, Develop Health works alongside Elation through two APIs: Elation's REST and FHIR APIs, whose FHIR data has run in near-realtime sync with the EHR since May 2026, and Develop Health's own REST API. Your engineering team or an integration partner connects them:
A prescription event in Elation triggers a benefit verification or PA request to Develop Health, with chart notes and labs attached as evidence.
Develop Health prepares the PA and either submits it and handles payer follow-up for you (delegated) or sends your reviewer a link to approve it first (non-delegated).
Webhooks push every status change back, so determinations land wherever your team already works.
Providers keep prescribing exactly as they do today.
What it automates that the options above don't:
Coverage checks before the pharmacy rejection: real-time benefit verification returns coverage, PA requirements and out-of-pocket cost, so nobody waits to initiate by hand.
Evidence without PDF printing: AI pulls supporting clinicals from historical notes and labs, then fills payer question sets with cited documentation.
Coverage beyond Surescripts PBMs: ePA where rails exist, AI phone calls and fax where they don't, with human fallback.
One single status: status checks and webhooks track every request, including PBM follow-ups.
The other half of the process: denial-reason analysis, AI-generated appeal letters and resubmission, including for PBMs without electronic appeals.
Develop Health reports an 83% reduction in medication-access admin work across hundreds of thousands of patients per month, plus a 14% lift in approval rates and prescription-to-approval cycle times cut from about 1.5 weeks to roughly 20 hours. In one case study, Arches Primary Care processed about 800 prior authorizations in six weeks, cutting turnaround from weeks to two days.
Pricing: Small per PA or per provider fee; free if sponsored by pharmacy or manufacturer.
Best for: Elation organizations with high pharmacy-benefit volume (GLP-1s, ADHD medications, biologics) and the technical capacity to connect an API, such as digital health companies and multi-site primary care groups.
Where it stops: It focuses on pharmacy-benefit PAs, so referral and imaging auths stay with Option 3.
Side-by-Side: PA Options in Elation
Elation native ePA | CoverMyMeds | Payer portals + Elation Billing | Develop Health | |
PA type | Pharmacy benefit | Pharmacy benefit | Medical benefit | Pharmacy benefit |
Cost | Built into Elation EHR | Free | Staff time | Small per PA or per provider fee; free if sponsored by pharmacy or manufacturer |
Where it lives | Inside Elation (ePA Worklist) | Separate portal | Payer portals; auth stored in Elation | Your systems, via API and webhooks |
Who initiates | Prescriber or delegate, manually | Pharmacy or staff | Staff | Triggered by Rx events via API |
Evidence gathering | PDFs uploaded by hand | Entered by staff | Uploaded per payer portal | AI extraction with citations |
Denials + appeals | E-appeals where the PBM supports them | Manual | Manual | AI-generated appeals |
Automation level | Low to medium | Low | None | High (end-to-end) |
Automate the PAs Elation's Native Tools Can't
Elation's native ePA is the right place to start. But the PA work that burns the most staff hours (PBMs outside Surescripts, evidence gathering for specialty drugs, denials and appeals) sits outside what Elation automates today.
Develop Health automates that complete pharmacy-benefit cycle through an API that works alongside Elation, with no change to how providers prescribe. Book a demo to see how it fits your workflow.
Frequently Asked Questions
Does Elation EHR support electronic prior authorization?
Yes, for prescriptions. Since July 2025, prescribers and their delegates can initiate ePAs from the Prescription Form and manage them in the ePA Worklist. It works for patients whose PBM supports ePA through Surescripts; referrals, imaging and procedures aren't covered.
Can Elation automatically start a PA when a drug requires one?
No. Elation's help center confirms ePAs must be initiated manually. Real-Time Prescription Benefit can flag the requirement, but someone still has to select "Initiate ePA." API-based platforms like Develop Health can trigger benefit verification and PA preparation automatically from prescription events.
Do CoverMyMeds prior authorizations show up in Elation's ePA Worklist?
No. Requests started in CoverMyMeds don't flow into Elation. To track a PA in the ePA Worklist, it has to be initiated from Elation's Prescription Form.
How do I handle prior authorizations for referrals and imaging in Elation?
Submit them through the payer's portal or by fax, then record the approval in Elation Billing with the Auth button in the patient's insurance box and attach it to the claim. Since May 2026, you can also enter PA details at scheduling so they sync to the claim automatically.
Can third-party prior authorization tools connect to Elation?
Yes. Elation offers REST and FHIR APIs and a Partner Hub for integrated vendors. API-first platforms like Develop Health expose REST endpoints and webhooks that your team or an integration partner connects to Elation, so PA statuses flow back into your existing workflow.
