In a 2020 American Academy of Dermatology survey, dermatology providers and staff reported that 24% of patients need a PA and that they spend 3.3 hours a day on them.

If your practice runs on ModMed's EMA, your prior authorization workflow probably lives in two places. Partly in EMA's ePA queue, and partly in a mixture of payer portals, faxes and phone calls. 

This guide breaks down the five ways ModMed practices get PAs done, where each one stops, and which fits your specialty.

What "Integrated With ModMed" Actually Means

Nearly every PA vendor claims a ModMed integration, but there are four very different ways to connect to EMA:

• Certified FHIR API: ModMed's Certified FHIR API supports only read, search and bulk export. Vendors can pull chart data but can't write anything back.
  
  

• EMA Proprietary API: ModMed's proprietary API supports creating and updating records, but vendors need ModMed's approval to use it, typically as synapSYS Marketplace partners.
  
  

• Automation inside your EMA instance: Software works in EMA through a dedicated user account, the way a staff member would: reading charts, working queues and recording outcomes. No partner approval is required.
  
  

• People inside your EMA instance: Outsourced staff log in with their own credentials and do the work by hand.

None is automatically better. Ask every vendor three questions: What does it read? What does it write back, and where? Does anyone on my team still have to touch it?

Our advice: Ask vendors to walk you through a completed PA in a live ModMed environment, from prescription to determination. A slide that says "integrates with ModMed" tells you nothing about which of these four paths it uses.

The 5 Ways to Do Prior Authorizations in ModMed

Option 1: ModMed's Native ePA and Real-Time Prescription Benefit

ModMed added Surescripts electronic prior authorization and Real-Time Prescription Benefit to EMA in 2018. EMA's ePrescribing module lets staff initiate and track PAs from an ePA Rx queue, while Real-Time Prescription Benefit shows the patient's likely out-of-pocket cost before the prescription is sent.

When a medication needs a PA and the patient's PBM is on the Surescripts network, the payer's question set arrives electronically. Staff answer it, upload visit notes or attachments, submit, track the determination and even file an appeal from the same queue.

Best for: Every ModMed practice. If prospective ePA and Real-Time Prescription Benefit aren't used at the point of prescribing, fix that before evaluating any vendor. Seeing coverage up front lets providers choose a covered alternative while the patient is still in the room.

Where it stops: It only automates what flows over the ePA rails. Staff still answer every question set and hunt through the chart for step-therapy evidence. Non-connected payers and pharmacy-initiated requests that arrive by fax stay outside the queue, and every denial and appeal is still worked by hand.

Option 2: Payer Portals and CoverMyMeds (Outside EMA)

Whatever EMA's ePA can't reach, staff handle outside the EHR: PBM portals, fax forms, phone calls or CoverMyMeds, which is free for providers and covers virtually any medication and plan.

Best for: Lower-volume practices, and the long tail of plans native ePA doesn't reach.

Where it stops: Everything happens outside EMA. Staff re-key patient details, upload chart notes to each portal and record outcomes back in EMA by hand. Tracking usually ends up in spreadsheets, which is where PAs get lost. It's electronic transmission, not automation.

Option 3: Outsourced or Virtual PA Staff

Many ModMed practices hand PAs to a billing company, virtual assistant firm or offshore team whose staff log into EMA and payer portals with their own credentials. Several firms specialize in ModMed's queues and specialty protocols.

The American Academy of Dermatology Association has told Maryland legislators that dermatology practices spend an average of $40,000 to hire or redistribute staff for PA work, and outsourcing moves that cost off your payroll.

Best for: Practices with a backlog, high turnover, or complex medical-benefit cases that need peer-to-peer reviews and payer calls.

Where it stops: Outsourcing only shifts the work. Every PA still goes through the same manual steps, costs scale with volume, and quality depends on the vendor's training and retention. You're also giving outside users access to PHI, so BAAs, MFA and tight permissions are non-negotiable.

Option 4: Medical-Benefit PA Tools That Connect to ModMed

Retina, orthopedic and pain practices need medical-benefit specialists. SamaCare offers a PA platform for physician-administered medications, free for qualifying practices, with an interface to ModMed's ophthalmology solution since 2022. For imaging and procedures, clearinghouse and RCM vendors offer authorization modules that check payer rules and submit electronically.

Regulation is helping here too. Since January 2026, CMS-0057-F has required Medicare Advantage, Medicaid and CHIP plans to decide non-drug PAs within 72 hours for urgent requests and seven days for standard ones.

Best for: Ophthalmology, retina, orthopedics, pain management and any practice whose PA volume is mostly procedures and in-office drugs.

Where it stops: These tools don't touch pharmacy-benefit PAs, and integration depth varies widely, so apply the three questions above.

Option 5: AI-Native Medication PA Automation (Develop Health)

Develop Health automates the full pharmacy-benefit PA cycle for ModMed practices, from benefit verification through approval or appeal.

Develop connects through secure automation that works inside your existing EMA instance, so there's no partner integration project to wait for, and providers keep prescribing exactly as they do today. For MSOs and groups with integration teams, Develop's API also offers REST endpoints for benefit verification, PA submission and status checks, with webhooks that push status changes back to your systems.

What it automates that options one to four don't:

• Benefit verification before the pharmacy rejection: Coverage, PA requirements and out-of-pocket cost are checked up front, and the platform flags when a PA isn't required or a formulary alternative is.
  
  

• Evidence-backed form completion: AI pulls supporting clinicals from historical notes, labs and medication history, then answers payer question sets with cited documentation. For a psoriasis biologic, that means documenting the failed topicals, phototherapy or prior biologics that step-therapy criteria demand.
  
  

• Submission everywhere: ePA where rails exist, AI phone calls and fax where they don't, with human fallback.
  
  

• The back half of the process: Determination follow-up, denial-reason analysis, AI-generated appeal letters and resubmission.

You also choose how much control to keep. In a delegated workflow, Develop prepares, submits and follows up on each PA. In a non-delegated workflow, your reviewer checks the prefilled answers and evidence before anything reaches the payer.

Across our customers, we've seen an 83% reduction in medication-access administrative work, a 14% lift in approval rates and prescription-to-approval time cut from roughly 1.5 weeks to about 20 hours. Arches Primary Care processed roughly 800 PAs in six weeks, cutting turnaround from weeks to two days.

Best for: Dermatology, GI, allergy and other ModMed practices with high volumes of biologics and specialty medications.

Where it stops: Develop focuses on pharmacy-benefit PAs. For retina injections, imaging or surgical authorizations, look at Options 3 and 4.

Side-by-Side: Prior Authorization Options in ModMed

Which PA Approach Fits Your ModMed Practice?

Most practices combine two or three of these. Start with your specialty:

• Dermatology, GI and allergy: Use native ePA and Real-Time Prescription Benefit at the point of prescribing, then automate the rest of the medication PA cycle with Develop Health. Keep CoverMyMeds as a fallback for outliers.
  
  

• Ophthalmology and retina: Pair a medical-benefit platform for buy-and-bill drugs with native ePA for prescriptions.
  
  

• Orthopedics and pain management: Route imaging and procedure authorizations through RCM tools or an outsourced team; native ePA usually covers the lighter medication volume.
  
  

• Multi-specialty groups and MSOs: Use one tool per benefit type and centralize status tracking through APIs. If some of your practices run other EHRs, see our guides to prior authorization in athenahealth and prior authorization in Epic.

Frequently Asked Questions

Does ModMed have built-in prior authorization?

Yes, for medications. EMA's ePrescribing module supports Surescripts ePA from an ePA Rx queue, plus Real-Time Prescription Benefit for out-of-pocket cost. It only reaches payers on the ePA network, so other plans still need portals or fax, and denials and appeals are still worked by hand.

Does ModMed have AI for prior authorization?

ModMed is building toward it. Its AI-Powered Practice vision includes assistants for eligibility, prior authorization and claim denial appeals, but the RCM AI Platform it announced in August 2026 focuses on claims rather than PAs. It requires ModMed Practice Management, with an early adopter program planned for Q4 2026 and broader availability in 2027.

Can I use CoverMyMeds with ModMed?

Yes. CoverMyMeds' web portal is free for providers and works for virtually any medication and plan. Because it runs outside EMA, though, staff re-enter patient details, upload chart notes and record outcomes in EMA by hand.

Is it safe to let a PA vendor work inside EMA?

It can be, with the right controls: a signed BAA, dedicated user accounts with MFA, permissions limited to PA work, and an audit trail of every action. Develop Health is HIPAA compliant and SOC 2 Type 2 certified, and confidence thresholds route uncertain AI outputs to human review.

Will new CMS rules speed up medication PAs?

Not yet. CMS-0057-F's 72-hour and seven-day decision deadlines don't apply to drugs. In April 2026, CMS proposed a separate rule requiring drug PA decisions within 24 hours for urgent requests and 72 hours for standard ones, but it was still a proposal at the time of writing.

Automate the Medication PAs ModMed Can't

ModMed's native ePA is the right foundation. But the work that burns staff hours (gathering step-therapy evidence, chasing non-connected payers, fighting denials) sits outside what EMA automates. 

Develop Health automates that complete medication PA cycle inside your existing ModMed workflow. Book a demo to see it on your own PA volume.