NextGen Healthcare has had electronic prior authorization built into its e-prescribing workflow for over a decade: Surescripts CompletEPA in NextGen Enterprise since 2015 and a free CoverMyMeds integration in NextGen Office. 

And yet, in the ambulatory and specialty practices NextGen serves, PA remains one of the largest staff time sinks. The 2025 AMA Prior Authorization Physician Survey puts the workload at roughly 13 hours of physician and staff time per week, per physician. NextGen's built-in ePA electronically transmits PA requests, but someone still has to complete them. Benefit verification, clinical evidence, payer follow-up, denials, and appeals all remain manual.

This guide breaks down the three ways NextGen practices actually get medication PAs done: what each covers, where each stops, and how to decide which combination fits your volume.

The 3 Ways to Do Prior Authorizations in NextGen

Option 1: NextGen's Built-In ePA (CoverMyMeds + Surescripts)

NextGen's electronic prior authorization is embedded directly in the prescribing workflow of both platforms, on two different rails. In NextGen Enterprise, Surescripts CompletEPA has connected prescribers to the major PBMs since 2015, with ePA enabled and configured in the Enterprise EHR's ePrescribing preferences. NextGen Office, the cloud platform for independent practices, ships with a free CoverMyMeds ePA integration that covers electronically connected payers and digitally faxes the PBMs that still run on paper.

In practice, this means two things. First, prescribers can be alerted that a PA is required before the prescription goes to the pharmacy, and initiate the request prospectively with patient, prescriber, and medication data pre-populated from the chart. In NextGen Enterprise, ePA can auto-initiate when a medication is saved to the chart if a Real-Time Prescription Benefits check or the formulary flags a PA requirement. Second, PBM question sets, status updates, and denial tasks surface as ePA tasks inside the Medications module, with determinations and payer documents routing back into the chart as ePA notes rather than arriving as faxes.

Benchmarks published in the NextGen ecosystem put the reduction at about 20 minutes per PA down to roughly 5, and turnaround from 3-5 business days down to 1-2, because staff no longer re-key demographics or chase fax confirmations. Moreover, prospectively initiated PAs get patients on therapy an average of 13.2 days sooner than retrospective ones, yet only about 17% of PAs are initiated at the point of prescribing.

Best for: Every NextGen practice. It is free, it is native, and if the ePA prompt at prescribing isn't enabled and adopted, fix that before evaluating anything else.

Where it is limited: This is only transmission infrastructure. The payer's clinical question set still lands in front of a staff member who must locate the supporting evidence in the chart and answer each question. Nothing verifies benefits before the visit, nothing tracks stalled requests, and nothing touches denials or appeals. NextGen does not offer AI-drafted PA answers on top of its ePA rails.

Option 2: The Portal-and-Fax Layer

Every PA that falls outside the electronic rails, whether for a payer without ePA connectivity, a specialty drug whose criteria demand documentation beyond the electronic question set, or any denial that needs an appeal, gets worked manually. In most NextGen practices that means some combination of the standalone CoverMyMeds web portal, which is free to prescribers and covers all drugs and all plans including Medicare Part D and Medicaid, individual payer and PBM portals with separate logins, and fax for the payers that still require it.

For practices below a certain volume, the standalone CoverMyMeds portal can be enough, and pharmacy-initiated requests can be completed in-workflow rather than by phone. But it is limited. Staff toggle out of NextGen to work requests, re-enter clinical details the portal can't pull from the chart, and manually track every open request across every portal. Nearly half of all PAs are still submitted by phone and fax, and in the ambulatory and specialty offices NextGen serves, that load lands on front-office staff rather than the centralized PA departments large health systems can afford.

Best for: Low PA volume, or as the overflow channel for edge cases regardless of what else you run.

Where it is limited: It doesn't scale. This is the layer where the follow-up calls, the resubmissions, the appeals written from scratch, place the heaviest burden on staff. Every additional GLP-1 or biologic prescription adds linear staff time, and the work is invisible until a backlog forms.

Option 3: End-to-End AI Automation (Develop Health)

The third approach automates the cycle that Options 1 and 2 leave manual, by connecting an automation platform to NextGen itself.

Develop Health integrates directly within NextGen, through an RPA-based integration. The platform works inside the EHR the same way a staff member would, reading prescription and chart data and writing statuses back, so there is no engineering work required on the practice's side. This is the same deployment model Develop Health already runs for other EHRs, including eClinicalWorks and ModMed EMA, rather than something being attempted for the first time on NextGen.

For organizations that want a custom build, there is also a documented API path. NextGen exposes an Enterprise API with 800+ RESTful routes enabling read and write transactions across EHR, PM, and clinical data, alongside FHIR R4 endpoints, governed through its API Developer Program, and Develop Health exposes a REST API with webhook support for benefit verification, prior authorization submission, and status events. 

This is the right option for digital health companies and larger groups with their own engineering teams who want PA automation integrated into a custom stack, by connecting prescription events to Develop's endpoints directly, or through NextGen's Mirth Connect engine, which many practices already run for HL7 interfaces.

Develop Health runs real-time benefit verification before the visit, surfacing coverage, PA requirements, and out-of-pocket cost including applicable copay programs. When a PA is required, it sources the correct payer form, extracts the supporting clinical evidence from chart notes and labs with citations, completes the question set, and submits via ePA, AI-powered phone calls, or fax, with human fallback for full payer coverage. It then chases determinations, analyzes denial reasons, and generates appeal letters.

In a recent case study, Calibrate reported a 70% reduction in hands-on PA time and a 5-7x decrease in the number of PAs required per member. Our customers report an 83% reduction in PA handling time, a 14% improvement in approval rates, and prescription-to-approval cycles cut from roughly 1.5 weeks to about 20 hours. Develop Health’s platform automates access for more than 400,000 patients per month and charges a small per PA or per provider fee (or it’s free if sponsored by the pharmacy or manufacturer).

Best for: 

• Practices with high pharmacy-benefit PA volumes, especially those managing specialty medications like GLP-1s, biologics, or ADHD drugs.
  
  

• Also a strong fit for digital health companies, specialty pharmacies and any practice that wants to eliminate PA-related staff overhead without replacing tools or changing how providers prescribe.

Where it is limited:

• Develop Health focuses primarily on pharmacy-benefit PAs, it is not the right solution if your primary volume is medical-benefit authorization (procedures, imaging, referrals).

Side-by-Side: PA Options in NextGen

Ready to Reduce Your PA Workload in NextGen?

NextGen's built-in ePA helped fix the transmission problem years ago. What it never solved is the completion problem: the question sets, the benefit checks, the follow-up, and the appeals that still consume staff hours every week. If your practice is carrying high GLP-1, biologic, or specialty PA volume on NextGen and the portal-and-fax layer has become a hiring plan, Develop Health's API-based automation is worth evaluating: it covers the full cycle the native rails leave open, with no change to how your providers prescribe.

Frequently Asked Questions

Does NextGen have built-in electronic prior authorization?

Yes. Both NextGen Enterprise and NextGen Office include ePA through integrations with CoverMyMeds and Surescripts CompletEPA, embedded in the e-prescribing workflow at no additional cost. It handles electronic transmission and pre-populates demographic data, but staff still complete payer question sets and manage denials manually.

How do I set up ePA in NextGen?

For NextGen Enterprise EHR, ePA is configured through the electronic prior authorization setup in the Enterprise EHR help documentation; determinations then appear as ePA notes in the patient chart. NextGen Office practices enable the CoverMyMeds workflow within the EHR/PM platform. In both cases, verify that prospective PA prompting at prescribing is turned on, not just retrospective handling of pharmacy rejections.

How do third-party PA tools connect to NextGen?

Two ways. Some platforms, including Develop Health, integrate directly, using RPA, within the EHR: reading prescription and chart data and writing statuses back the way a staff member would; which requires no development project from the practice. 

For custom builds, NextGen's Enterprise API offers 800+ RESTful routes and FHIR R4 endpoints under the NextGen API Developer Program, many practices run NextGen's Mirth Connect engine for HL7-based interfaces, and Develop Health exposes REST endpoints and webhooks that connect to prescription events and return status updates.

Does Develop Health have a native NextGen integration?

Yes, in two ways. The standard deployment integrates directly within NextGen with no development work required from the practice, through RPA-based automation. This is the same model Develop Health runs for other ambulatory EHRs such as eClinicalWorks and ModMed EMA. 

For organizations that want a custom connection, such as digital health companies with their own engineering teams, Develop Health also provides a documented REST API with webhook support that connects via NextGen's Enterprise API, FHIR endpoints, or Mirth Connect. Either way, the full cycle (benefit verification, form completion with cited evidence, submission, follow-up, and appeals) runs without prescribers changing how they work in NextGen.

How long does a medication PA take in NextGen?

It depends entirely on the path. Electronically transmitted PAs to connected payers can return determinations in hours, and 62% of electronic submissions receive a determination within two hours. Manually worked portal-and-fax PAs historically run 1-2 weeks end to end. End-to-end automation has cut the full prescription-to-approval cycle to roughly 20 hours for practices previously averaging 1.5 weeks.