Counter Guide
Tracking prior authorizations
Prior auth cases track who owes the next move — prescriber, payer, patient, or pharmacy — and when to check back. Refillops does not approve or deny PAs; it keeps the follow-up on time.
When to use this
- A claim rejection indicates prior authorization is required.
- A prescriber office has confirmed they are submitting a PA and the pharmacy is waiting.
- A payer has placed a PA in pending status and a follow-up date is set.
Step by step
- 1
Read the PA statuses
Not started — no PA has been requested yet. Prescriber follow-up — waiting on the prescriber office to submit or supply info. Payer pending — submitted, waiting on payer. Patient update due — patient needs to know the timeline. Approved / Denied / Cancelled — closed.
- 2
Use prescriber follow-up correctly
Set the prescriber contact and the requested-by date. Log every outbound call or fax with a short note. The follow-up timeline shows the gap since the last contact.
- 3
Use payer pending correctly
Record the date the PA was submitted, the payer’s expected turnaround, and any reference number returned. Set the next check-back date so the case surfaces back in the queue.
- 4
Mark patient update due
When the patient should be informed (delay expected, additional info needed), mark patient update due. This puts a drafting card in Patient Updates.
- 5
Read the timeline
The PA timeline shows submission, follow-ups, status changes, and notes side-by-side so a new team member can pick the case up cold.
Common mistakes
- Leaving a PA in ‘Payer pending’ with no check-back date.
- Marking ‘Approved’ from a phone call without recording who said it and when.
- Creating a new PA case instead of reopening the existing one when a payer asks for a resubmission.
Safety & trust
PA status must be entered or confirmed by the pharmacy team. Refillops does not communicate with payers on your behalf and does not change PA outcomes.
Still need help?
Contact Refillops support and we’ll get back to you.