Smarter Week

How to automate it

How to automate “fix insurance rejections on prescription claims”

Here are 2 ways to spend less time on this, best first. Each comes with steps you can follow today.

60 min
typically, every day
50%
of the time can be automated
Some setup
to set up

Fix 1 of 2

Process fixBest fix

Keep a rejection-code playbook and work rejections in one queue

Most rejections are a handful of repeat codes (refill too soon, prior auth needed, non-formulary, plan limits). A one-page playbook with the fix for each, and one daily queue, stops techs reinventing the answer each time.

Typically saves about 35% of the time1 h to set up
  1. 1Pull the last month of rejections by NCPDP reject code and count them.
  2. 2For the top ten, write the standard fix (override code, PA route, formulary alternative to suggest to the pharmacist).
  3. 3Work rejections in one queue at set times, not as they pop up.
  4. 4Ask your system vendor about claim-rejection assistants or AI tools that suggest the resolution.

Tools: Your pharmacy system's rejection queue · CoverMyMeds for prior authorization

Fix 2 of 2

Software feature

Submit prior authorizations electronically from the EHR

Electronic prior authorization pulls the patient and clinical details from the chart, shows the payer's questions, and often returns an answer in minutes. New federal payer rules are making this more common through 2026 and 2027.

Typically saves about 40% of the time1 h to set up
  1. 1Ask which ePA tools are connected to your EHR (CoverMyMeds or Surescripts for drugs; Availity, Cohere or your EHR's payer platform for services).
  2. 2Start the request from the order in the EHR instead of a fax form.
  3. 3Save templates for your most common requests.
  4. 4Track pending requests in one work queue instead of a spreadsheet.
  5. 5Only use tools your organization has approved and covered by a HIPAA business associate agreement (BAA) for anything with patient information.

Tools: CoverMyMeds · Surescripts · Availity · Cohere Health · Epic Payer Platform

Who does this task

Roles in our library that list this as one of their common tasks. Each guide covers the rest of that role’s week.

Pharmacy technician

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Other common tasks for Pharmacy technicians