Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
EXPRESSPATH PROVIDER PORTAL USER GUIDE
AUGUST 2013
© 2013-2020 Express Scripts, Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopy, recording or any information storage and retrieval system, without the express written consent of Express Scripts, Inc.
All trademarks and service marks are the property of their respective owners.
This document is proprietary to Express Scripts, Inc. Unauthorized use and distribution are prohibited.
August 2013
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-1
Section 1: ExpressPAth Overview
ExpressPAth Overview ..................................................................................................1-3
Accessing ExpressPAth ..................................................................................................1-4
Creating a Desktop Shortcut for ExpressPAth ...........................................................1-5
Navigating .......................................................................................................................1-7
Printing ............................................................................................................................1-8
Accessing the User Guide ..............................................................................................1-9
Accessing Tutorials ........................................................................................................1-9
Using Support .................................................................................................................1-10
Logging In .......................................................................................................................1-12
Forgot Your User ID or Forgot Your Password .........................................................1-14
Forgot Your User ID? ..................................................................................................1-14
Forgot Your Password? ................................................................................................1-21
Logging Off .....................................................................................................................1-22
ExpressPAth Overview
1-2 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
This page is to remain blank.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-3
ExpressPAth Overview
The ExpressPAth Provider Portal - https://www.express-path.com - is a web-based
portal that can be used to request prior authorization for drugs and services for patients
who are covered under certain health plans’ pharmacy and/or medical benefits.
Prescribers and Providing Facility office managers can complete registration and
designate medical and non-medical staff to manage prior authorizations on their behalf.
ExpressPAth is available to registered users 24 hours a day, 365 days a year. The
convenience of an online tool allows the user to begin and complete an authorization
request on their schedule. Also, following up on a request is as simple as entering in
the patient information and viewing the results as time allows during a busy work day.
Using ExpressPAth has other advantages for providers and their office staff as well.
Here are just a few:
Increase efficiency by reducing paper forms, faxing time or time on the phone
Providers can manage their own information or designate others to request prior
authorizations on their behalf
Manage renewal requests electronically
Upload or fax additional documentation, such as lab results or other clinical
information, to support the prior authorization request
Accessing ExpressPAth
1-4 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Accessing ExpressPAth
ExpressPAth Provider Portal is compatible with Microsoft Internet Explorer (versions
6, 7, and 8) and Firefox. It is also supported by both Apple and Windows Safari
Browser.
To access ExpressPAth:
1. Double-click or the icon for your web browser.
2. In the Address field, type the ExpressPAth URL.
This URL is https://www.express-path.com
Notes: Do NOT add the ExpressPAth URL to your Favorites, or you may
have problems accessing the most current version of the Provider
Portal if we release a new version. You may add a shortcut (see
instructions on page 5 of this section).
Pop-up Ad Blocker must be turned OFF.
3. Press Enter
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-5
Creating a Desktop Shortcut for ExpressPAth
To create a Desktop shortcut for ExpressPAth:
1. Go to your Desktop.
2. Right click your mouse in any blank area on your Desktop.
A menu appears when you right-click.
3. Move your mouse to the “New” menu option.
A secondary menu appears.
Creating a Desktop Shortcut for ExpressPAth
1-6 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
4. On the secondary menu, select
The following box appears.
5. Place your mouse inside the text box. Type the URL below.
is https://www.express-path.com
6. Click The following box appears.
7. Type a name for the shortcut in the field provided. For this example, we will
use “ExpressPAth”.
8. Click The box closes.
The Desktop shortcut is now ready.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-7
Navigating
You can navigate through ExpressPAth using several methods.
To access different sections of ExpressPAth, use the tabs that are located at the
top of each page.
Hyperlinks are embedded into forms in the work area
And on the left side of pages
or
Buttons are embedded into left menus and into work area forms
The Stage Progress indicator at the top of the ExpressPAth work area checks
off steps as they are completed.
Printing
1-8 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Printing
Any user in ExpressPAth Provider Portal has the ability to print the screen using the
icon anywhere within the application. This print icon is located on every page
towards the top right corner of the screen.
Note: Only the information that appears on your screen display is printed.
If the record is longer than your screen display, you must scroll up
or down in the record and repeat the process above if you want to
print information further up or down in the record.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-9
Accessing the User Guide
You can access a PDF of the User Guide from a link within ExpressPAth.
To access the User Guide:
From any page, click Help in the top right corner of the screen.
A PDF of the ExpressPAth User Guide appears. You are automatically taken to a
specific point within the user guide based on the tab and/or link that you are working in
within ExpressPAth.
If you are not yet logged in to ExpressPAth, you will only see Section 1 (Overview)
and Section 2 (Registration and Settings). Once you login, you will also see all of the
remaining sections in the user guide.
Accessing Tutorials
You can access ExpressPAth video training modules from a link within ExpressPAth.
To access the tutorials:
1. From any page, click Tutorial in the top right corner of the screen.
A menu of tutorials displays. Based on the tab and/or link that you are
working in within ExpressPAth, you may see different tutorials that are
relevant to that section (e.g., not all tutorials that are available in ExpressPAth
will display in every tab).
2. Click on the desired tutorial to select it.
Navigational arrows, play & pause buttons display on the tutorial.
Note: There is no sound on any of the tutorial videos.
3. When the tutorial ends, you may replay it or click the red X to close it.
Using Support
1-10 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Using Support
You are able to request technical assistance by using the Support link.
To request technical assistance,
1. Click the Support link.
An email form opens.
2. Click the Priority dropdown arrow and select the priority of the issue. Press
Tab.
3. In the User ID field, type your User ID. Press Tab.
4. In the Enter your Email ID field, type your email address. Press Tab.
5. In the Subject field, briefly explain the issue that you are having with
ExpressPAth.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-11
6. In the Description field, type a detailed description of your ExpressPAth
technical issue.
Note: If your question is clinical, not technical, please contact the health
plan.
7. If needed, in the Attachment file field, click the Browse button and add an
attachment to the support request.
8. In the Enter the code as shown in Image field, type the code as seen in the
spatter box.
9. To submit your request for support, click
10. Someone on the ExpressPAth Support team will reach out to you as they work
to resolve your issue (typically within one to two business days).
Logging In
1-12 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Logging In
Login area displays before a user logs into ExpressPAth and is also
used for registration.
Work area contains active information and forms while working in
ExpressPAth.
NIH News contains links to National Institute of Health news.
To log in to ExpressPAth:
1. In the Enter your User ID field, type your previously selected User ID.
2. In the Enter your password field, type your previously selected case-
sensitive password.
Note: Your password for ExpressPAth expires every six months.
3. In the Enter the below text field, type the code number displayed in the
shaded security code area.
4. Click the Sign In button or press Enter on your keyboard.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-13
After you have registered or logged into ExpressPAth, the Prior Authorization Portal
for Providers page displays.
Prior Authorization, Settings, and Logout tabs display after a registered
user logs into ExpressPAth. The active tab is yellow.
Prior Authorization Portal for Providers contains hyperlinks and buttons
to initiate, complete, search for a previously submitted PA request, or search
for prior authorizations about to expire.
Note: If ExpressPAth is inactive for 20 minutes, you will automatically be
logged out of the tool. ExpressPAth will show you as logged out, but
a Login link on the page allows you to immediately log back in.
Forgot Your User ID or Forgot Your Password
1-14 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Forgot Your User ID or Forgot Your Password
Forgot Your User ID?
To recover your ExpressPAth User ID:
1. On the ExpressPAth Login tab page left column, click on the Forgot your
User ID link.
The I am a field dropdown displays.
2. To identify your role in ExpressPAth, click the dropdown arrow.
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-15
Your choices are Prescriber, Agent, or Providing Facility.
3. Select the role (which you chose during registration) that best describes you.
You are moved to the next step.
For Prescribers:
If you are a Prescriber, the form below displays.
1. In the Who is a field, click the dropdown and select the correct descriptor
(which you chose during registration) that best describes you.
2. You have a choice of which prescriber ID you enter. Select either the DEA,
NPI or SLID (State License ID) field and type the appropriate ID.
Note: Only your NPI is required during registration. DEA and State License
ID (SLID) are not required during registration. If DEA and State
License ID were not entered during registration, a search by DEA or
SLID will be unsuccessful.
Forgot Your User ID or Forgot Your Password
1-16 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
3. In the Email ID field, type your email address.
4. Click
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
5. In the Answer field, type the correct answer to the Secret question that you
selected during registration.
6. Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email message from ExpressPAth
stating, “The following User ID has been requested for (Requestor Name) :
abc123
The email contains a link to use “to continue, creating, modifying and
checking the status of prior authorizations with the User Id provided above.”
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-17
For Agents:
If you are an Agent, the form below displays.
1. In the I work at a field, click the dropdown arrow and select the correct
descriptor (which you chose during registration) that best describes your
office location.
2. In the NPI field, type the NPI of a prescriber or provider to whom you are
associated. This is a required field.
1. First Name and Last Name fields are optional.
4. Optional: In the PPI field, type the unique ExpressPAth Prescriber ID that
was sent to the Physician for whom you are an agent. This number is
available in the physician’s activation email.
5. In the Email ID field, type your email address. This is a required field.
6. Click
Forgot Your User ID or Forgot Your Password
1-18 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
7. In the Answer field, type the correct answer to the Secret question that you
selected during registration.
8. Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email message from ExpressPAth
stating, “The following User ID has been requested for (Requestor Name) :
abc123
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-19
For Providing Facilities:
If you are a Providing Facility, the form below displays.
1. In the I work at a field, click the dropdown and select the correct descriptor
(which you chose during registration) that best describes your office location.
2. You have a choice of which providing facility ID you enter. Select either the
DEA, NPI or SLID (State License ID) field and type the appropriate ID.
Note: Only your NPI is required during registration. DEA and State License
ID (SLID) are not required during registration. If DEA and State
License ID were not entered during registration, a search by DEA or
SLID will be unsuccessful.
3. In the Email ID field, type your email address.
4. Click
Forgot Your User ID or Forgot Your Password
1-20 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
If your information does not match the information in the system, the
following message displays.
If your information does match the information in the system, Secret
Question and Answer fields display as part of the Forgot your User ID?
login.
Note: The example shown is for an agent, but is similar for all users.
6. In the Answer field, type the correct answer to the Secret question that you
selected during registration.
7. Click
A message displays indicating that your user ID has been sent to your email
address.
When you open your email, you will see an email from ExpressPAth stating,
“The following User ID has been requested for (Requestor Name) : abc123.
The email contains a link to use “to continue, creating, modifying and
checking the status of prior authorizations with the User Id provided above.”
Getting ExpressPAth Overview
09/26/2011 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
1-21
Forgot Your Password?
After you have entered your user ID, if you are unable to recall your password:
1. Click the Forgot your password? link.
2. For your assigned role, follow the same instructions given for Forgot your
user ID?
Forgot Your User ID or Forgot Your Password
1-22 ExpressPAth User Guide
Sales & Marketing: Client Applications & Training
© Express Scripts, Inc.
09/26/2011
Logging Off
You can log off at any time.
To log off, click the Logout tab.
A message displays that you have successfully logged out.
Note: You will automatically be logged out of ExpressPAth after 20 minutes
of inactivity.
A link displays to log back in.
Section 2―ExpressPAth Registration and Settings
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-1
Navigating the ExpressPAth Login ...............................................................2-3
Registering Prescribers and Providers ..........................................................2-4
Registering as a Prescriber/Provider .................................................................2-6
Setting Your User ID and Password .................................................................2-10
Registering Agents ...........................................................................................2-12
Registering as an Agent ....................................................................................2-12
Settings - Managing Your Profile Information - Providers ........................2-22
My Information (Providers) ..............................................................................2-22
My Practice Locations (Providers) ....................................................................2-26
My Agents (Providers) ......................................................................................2-30
Adding an Agent ...............................................................................................2-31
Searching for an Agent ......................................................................................2-32
Settings - Managing Your Profile Information - Agents .............................2-40
My Information (Agents) ..................................................................................2-40
My Physicians (for Agents) ..............................................................................2-42
My Physician Agents (for Agents) ....................................................................2-51
Creating a List of Favorite Rendering Providers (Providers and Agents) 2-53
Viewing Your Favorites ....................................................................................2-53
My Favorite Rendering Providers .....................................................................2-54
Changing Your Password (Providers and Agents) ......................................2-63
Navigating the ExpressPAth Login
2-2 ExpressPAth User Guide
© Express Scripts, Inc. 06/01/2011
This page is to remain blank.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-3
Navigating the ExpressPAth Login
The Login Page is where registered users will login or new users will register to use
ExpressPAth. On the right side, NIH (National Institutes of Health) news is displayed.
When you launch ExpressPAth, the first page you will see is the Login Page.
Some of the elements you will encounter on this page include:
Login tab
Login area is where registered users log in to ExpressPAth and new users
register to use the tool. A security code displays and must be entered during
every login. When login is complete, users click the Sign in button to
proceed.
ExpressPAth work area: Displays a brief description of prior authorization
tasks that may be performed in ExpressPAth.
Help area: Help, Tutorial, and Support links are located here.
NIH News Column contains National Institutes of Health article links
Registering Prescribers and Providing Facilities
2-2 ExpressPAth User Guide
© Express Scripts, Inc. 06/01/2011
Registering Prescribers and Providing Facilities
These instructions are for registering the following ExpressPAth users:
Physicians Home Infusion Therapy Providers
Pharmacists Specialty Pharmacies
Nurse Practitioners Outpatient Facilities
Physician Assistants Dialysis Centers
To register as an ExpressPAth user:
1. Go to the ExpressPAth website at https://www.express-path.com.
2. On the ExpressPAth Login tab page left column, click on the Click Here to
Register link.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-5
During the registration process, the page display changes.
Stage Progress indicator at the top of the ExpressPAth work area checks off
steps in the registration process as they are completed.
Progress Bar displays on the left side of the page to visually indicate the
registration stage and the remaining steps.
Registering Prescribers and Providing Facilities
2-6 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Registering as a Prescriber/Providing Facility
Step 1: Terms and Conditions:
1. In the Image Verification Code field, type the code that you see in the picture.
2.. Read the Service Agreement. You will need to scroll down to review the complete
agreement.
3. To agree to the terms of the Service Agreement, click the Accept radio button.
4. Click
Clicking the Decline radio button terminates the registration process.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-7
Step 2: Define Your Role:
1. To the right of “I am a”, click the dropdown arrow
Note: Fields followed by a red asterisk (*) are required.
. Refer to the table below for assistance in populating these fields:
If you are registering as a:
In the following field:
Select from the following:
Prescriber
Who is a Physician
Physician Assistant
Pharmacist
Nurse Practitioner
Providing Facility
I work at a Physician Office
Home Infusion Therapy
Agency
Specialty Pharmacy
Outpatient Facility
Dialysis Center
Step 3: License Information and Upload License:
1. In the NPI field, type your NPI number. This is a required field.
NPI: The National Provider Identifier (NPI) is a unique identification number for health
care providers issued by the National Plan & Provider Enumeration System (NPPES) that
will be used by all health plans. NPIs are issued to health care providers in order to
submit claims or conduct other transactions specified by HIPAA.
Note: If you are registering as an individual prescriber or provider, use your individual
NPI. If you are registering as a providing facility, use your organizational NPI.
State License (optional): Number issued on a State Medical License by the state where
the physician practices medicine.
Registering Prescribers and Providing Facilities
2-8 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
To upload your license from an electronic file, click the Upload checkbox and then click the
button.
A copy of your license is required to validate your credentials.
2. Locate the license file saved on your computer and select it.
The file address will display in the field.
Note: The file must be 4MB or less and must be in JPG, TIFF, GIF, PDF, BMP, DOC
or DOCX format. The ExpressPAth Registration Validation team will validate
your credentials prior to sending your registration activation confirmation email
(within two business days of receiving a legible copy of your credentials).
3. To upload the file, click the button.
Note: If you do not have an electronic copy of your license, you can fax your license
by clicking the Fax checkbox. Then, download a copy of the fax cover sheet by
clicking on the hyperlink. Fill out the information requested on the cover sheet
and fax it along with a copy of your license to the fax number on the screen.
4. Click
If your NPI is located in the CMS (Centers for Medicare and Medicaid Services)
database, your demographic information will be pre-populated on the form.
If your demographic information is not found in the CMS database, you can enter it
manually.
Note: If you manually update your demographic information in ExpressPAth, you will
need to contact CMS in order for your updates to be reflected in that database.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-9
Step 4: About You:
1. Verify that this information is correct (all fields are editable, if necessary).
or
Manually enter the data.
2. In the Enter your Email ID field, type your email address.
You will be asked to enter your email address twice to validate this field. Both emails
must match.
To disable email notifications, place a check in the box next to the
box
Or
If you do not opt out, you will receive an email every day that there is activity in any of
the listed categories for PA’s that you are associated with:
LOW: You will receive a daily summary showing a total of all approvals, denials,
withdrawals, or PA’s requiring further information for that day.
MEDIUM (default): In addition to receiving low notification emails, you will get an
email each time a PA that you intiated (or a PA that you are associated with) requires
further information for you to enter/submit.
HIGH: In addition to receiving low and medium notifications, you will get an email
notification each time a PA you intiate or are associated with is approved, denied, or
withdrawn.
Registering Prescribers and Providing Facilities
2-10 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
3. In the Specialty field, click the Specialty dropdown and select your specialty
or
In the Taxonomy Code field, enter your taxonomy code number. The Health Care Provider
Taxonomy codes are national specialty codes used by providers to identify their specialty
category. The codes are created by the National Uniform Claim Committee (NUCC), which
is chaired by the American Medical Association. Paste the link below into your web browser
in order to obtain the list of taxonomy codes and to identify the correct code to use for your
specialty.
http://www.nucc.org/index.php?option=com_wrapper&Itemid=50
When one of these fields has been populated, the other field auto-populates.
4. Click
Setting Your User ID and Password
Step 5: Login Information:
1. To enter your User ID, in the User ID field, enter your own unique user ID, then click
the button to confirm that ID is available
or
To have ExpressPAth suggest a unique User ID for you, click the button.
2. In the Password field, type your password.
Note: Passwords must be at least six characters long and must contain at least one
upper case character, one lower case character, one digit and one special
character.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-11
3. In the Re-enter Password field, retype your password.
4. In the Secret Question field, click the dropdown arrow and select a secret question.
5. In the Answer field, type the answer to your secret question. If you forget your
password, this will be used to verify your identity.
To complete the registration process, click the button.
Step 6: Registration Complete:
A message displays that indicates that you will receive a confirmation/activation email
within two business days after the ExpressPAth Registration/Validation team has
received a legible copy of your state license/credential information.
IMPORTANT: Please add [email protected] to your list of email contacts so that
the activation confirmation email does not go to your Spam/Junk email folder.
6. Click the Close button to complete your registration.
7. Once the confirmation/activation email is received from the ExpressPAth team (usually
within two business days), you can begin using ExpressPAth for prior authorization
requests for patients with participating health plans.
Registering Prescribers and Providing Facilities
2-12 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Registering Agents
These instructions are for registering ExpressPAth users who are Agents. An Agent is anyone
who can perform Prior Authorization functions on behalf of a Prescriber or Providing Facility.
Examples of Agents include medical or non-medical office staff such as:
Office Managers
Administrative Assistants
Secretaries
Nurses
Important: An Agent cannot register until their associated Prescriber or Providing
Facility has completed the registration process in ExpressPAth. The
Prescriber/Providing Facility does not have to be activated for the agent to
register.
To register as an ExpressPAth Agent:
1. Go to the ExpressPAth website at https://www.express-path.com.
2. On the ExpressPAth Login tab, click on the Click Here to Register link on the left-
hand side.
The ExpressPAth Home Tab displays.
Registering as an Agent
Step 1: Terms and Conditions, as follows:
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-13
2. In the Image Verification Code field, type the code that you see in the picture.
3. Read the Service Agreement. You will need to scroll down to review the complete
agreement.
4. To agree to the terms of the Service Agreement, click the Accept radio button.
5. Click
Clicking the Decline radio button terminates the registration process.
Step 2: Define Your Role form: On the I am a dropdown list, select Agent.
Registering Prescribers and Providing Facilities
2-14 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
7. Step 3: License Information:
8. In the I work at a field, click the dropdown arrow.
9. Select the appropriate agent work location description.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-15
You must associate yourself to a physician or providing facility by one of the
following:
by NPI
by Facility Name
by First and Last Name
PPI
Note: PPI is a unique ExpressPAth ID that is sent to the Physician when they register.
This number is available in the physician’s activation email and is not a required
field.
Search for an existing physician: enter required information to locate a prescriber or provider:
1. In the NPI field, type the prescriber or providing facility’s NPI number
or
In the Facility Name field, type the name of the providing facility
or
In the First Name field and the Last Name field, type the prescriber or provider’s
name.
2. Click
If the physician is located, the Prescriber Search box displays.
Registering Prescribers and Providing Facilities
2-16 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
3. If the correct physician is displayed, in the Prescriber Name field, click the
prescriber’s name hyperlink.
Note: If more than one page of records is returned, use the left and right arrows on the
bottom right to navigate back and forth within the records.
Step 3: License Information: redisplays in the work area, with the NPI and Name fields
populated with the prescriber information.
4. If you support more than one physician, you will repeat the search information for
additional physicians by clicking
You may add up to 10 prescribers/providers during registration.
Note: Additional prescribers/providers can be added by accessing the Settings tab and
adding them through the My Physicians link once you have completed your
registration. See the Settings - Managing Your Profile Information – Agents
section for instructions on how to add prescribers/providers through your
Settings tab.
5. When all physicians (up to ten) have been added to your profile, click
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-17
Step 4: About You:
1. In the First Name field, type your first name (required field).
2. In the Last Name field, type your last name (required field).
3. In the Enter your email address field, type your email address (required field).
4. In the Retype Email ID field, type your email address again (required field).
To disable email notifications, place a check in the box next to the
box
or
If you do not opt out, you will receive an email every day that there is activity in any of
the listed categories for PA’s that you are associated with:
LOW: You will receive a daily summary showing a total of all approvals, denials,
withdrawals, or PA’s requiring further information for that day.
MEDIUM (default): In addition to receiving low notification emails, you will get an
email each time a PA that you intiated (or a PA that you are associated with) requires
further information for you to enter/submit.
HIGH: In addition to receiving low and medium notifications, you will get an email
notification each time a PA you intiate or are associated with is approved, denied, or
withdrawn.
5. Click
Registering Prescribers and Providing Facilities
2-18 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Step 5: Login Information:
1. In the User ID field you may enter your own unique user ID, then click the
button to confirm that ID is available.
or
To have ExpressPAth suggest a unique User ID for you, click the button.
2. In the Password field, type your password.
Note: Passwords must be at least six characters long, and must contain at least one
upper case character, one lower case character, one number and one special
character.
3. In the Re-enter Password field, retype your password.
4. In the Secret Question field, click the dropdown arrow and select a secret question.
5. In the Answer field, type the answer to your secret question. If you forget your
password, this will be used to validate you.
6. To complete the registration process, click the button.
The Registration Complete page displays in the work area, shaded, with a Thank You
popup message in front. It describes how an email has been sent to each of the
designated providers with instructions for them on how to activate the Agent’s account.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-19
7. To exit, click
Prescriber/Provider Confirms Association to Agents
The last step to allow agents to perform Prior Authorization tasks on their behalf is for the
prescriber/provider to finalize the agent’s association request.
The prescriber/provider receives an Agent Authentication email that an agent has requested
association to them. Within the email there is a link to the Agent Authentication form.
To confirm an agent association to a prescriber/provider:
1. Click the link provided in the email from ExpressPAth (([email protected]) or
paste the URL in the email into your internet browser address bar.
Note: You will need to login before you are taken to the agent authentication form.
Registering Prescribers and Providing Facilities
2-20 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The My Agent page displays.
2. Set the Agent Status field to Active.
Other Agent information fields become available.
The Start Date default is today’s date.
3. To change the start date, in the Start Date field type the start date in the following
format: MM/DD/YYYY
4. In the Deactivate Agent on field, change the date from today’s date to any date in the
future. If you wish to make this agent active until you manually deactivate them, type
in 12/31/2099 in this field.
5. In the Assign Privileges area, select all of the privileges you want to apply to this
agent.
6. When all of the desired check boxes are populated, click the button
A pop-up confirmation message displays and an email is sent to the Agent to notify
them that they are now able to perform Prior Authorization tasks on behalf of the
prescriber/provider.
Note: The prescriber/provider’s account must have been validated and activated in
order for the agent to perform PA tasks for that prescriber/provider.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-21
7. Click
The Settings tab opens on the My Agents page. Click the Home link near the top left
corner of the screen to return to the ExpressPAth landing page.
Settings - Managing Your Profile Information - Providers
2-22 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Settings - Managing Your Profile Information - Providers
By accessing the Settings tab in ExpressPAth, you are able to manage your profile information,
including editing your information and changing your password. Providers and providing
facilities are also able to view, edit, or add practice locations and add agents, deactivate agents
and manage associated agents’ privileges.
My Information (Providers)
Viewing Your Credential Information
1. Click on the Settings tab.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-23
The Settings page displays in the work area with the Account Home menu open.
2. Click the My Information link.
or
Click My Information
The My Credential Information page displays.
Locked fields display with gray text. These cannot be edited.
Editable fields display with black text.
Settings - Managing Your Profile Information - Providers
2-24 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Editing Your Credential Information
1. Click on the Settings tab.
2. Click the My Information link.
The My Credential Information page displays.
3. You may edit any editable field (those without greyed out text).
Note: The Address fields, Work Phone, Email, Specialty, Taxonomy Code and
Secret Question and Answer fields are editable and required, as indicated by a
red asterisk (*).
4. To save your edits, click
Note: If the email associated to you is shared by another user ID, a popup message
will display, asking “Are you sure you would like to continue to update the
system with this email address?”
Click to continue.
or
Click to end the action.
Note: Any Agent with Office Manager privileges is able to edit a provider’s My
Information page. They are not able to change the provider’s password or
secret question/answer.
Note: Any updates made to your profile in ExpressPAth will not be reflected in the
Centers for Medicare and Medicaid Services (CMS) database. Please contact
CMS to ensure your records on file are current.
E-mail Summary
To disable email notifications, place a check in the box next to the
box
or
If you do not opt out, you will receive an email every day that there is activity in any of
the listed categories for PA’s that you are associated with:
LOW: You will receive a daily summary showing a total of all approvals, denials,
withdrawals, or PA’s requiring further information for that day.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-25
MEDIUM (default): In addition to receiving low notification emails, you will get an
email each time a PA that you intiated (or a PA that you are associated with) requires
further information for you to enter/submit.
HIGH: In addition to receiving low and medium notifications, you will get an email
notification each time a PA you intiate or are associated with is approved, denied, or
withdrawn.
Settings - Managing Your Profile Information - Providers
2-26 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
My Practice Locations (Providers)
Viewing Practice Locations
1. Click on the Settings tab.
2. Click the My Practice Locations link.
or
Click My Practice Locations
A list of Practice Locations associated to you displays.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-27
Editing a Practice Location
1. Click on the Settings tab.
2. Click the My Practice Locations link.
or
Click the My Practice Locations
A list of My Practice Locations associated to you displays.
3. Click the Edit link associated to the desired location.
The existing location information displays as a form.
4. Make edits to the location.
Note: Fields marked by a red asterisk (*) are required fields and must be
populated.
5. To save your changes, click
or
To cancel without saving your changes, click
Settings - Managing Your Profile Information - Providers
2-28 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
ExpressPAth saves the changes to the selected practice location and returns
you to My Practice Locations.
Adding a Practice Location
1. Click on the Settings tab.
2. Click the My Practice Locations link.
or
Click the My Practice Locations
A list of Practice Locations associated to you displays.
3. Click the Add link.
A blank location form displays.
4. Enter information for the added practice location to the form.
Note: The Address Line1, City, State, Zip, and Type (only one primary
location type is allowed – all others must be secondary) fields are
required.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-29
5. Click
ExpressPAth saves the new practice location and returns you to My Practice
Locations.
Deleting a Practice Location
1. Click on the Settings tab.
2. Click the My Practice Locations link.
or
Click the My Practice Locations
A list of My Practice Locations associated to you displays.
3. Click the Edit link associated to the desired location.
The existing location information displays as a form.
4. Click .
ExpressPAth returns you to My Practice Locations. The deleted practice
location is no longer listed.
Settings - Managing Your Profile Information - Providers
2-30 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Note: Any Agent with Office Manager privileges is able to manage their
associated provider’s My Practice Locations profile. They are able to
add, edit or delete practice locations on behalf of the provider.
My Agents (Providers)
Registered Providers and their Agents designated as Office Managers are able to
initiate, confirm and manage agent associations in ExpressPAth. The My Agents page
is used to assign, edit, or remove agent privileges, and to add additional agents.
To view My Agents:
1. Click on the Settings tab.
The Settings page displays with the Your Options menu open.
2. To view your associated agents, click the My Agents link.
or
Next to My Agents click
The My Agents page displays in the work area.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-31
In the My Agents area, a list of agents to whom you are associated displays.
Note: The current privileges assigned to an agent are listed in the Privileges
field.
Adding an Agent
You are able to initiate an association to an agent by locating the agent and adding the
agent to your agent list. The agent must be registered and associated to at least one
other provider in the ExpressPAth Provider Portal in order for the agent to return in the
search results.
To add an agent:
In the upper right corner of the My Agents page, click the My Agents Add
link.
Settings - Managing Your Profile Information - Providers
2-32 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The Search for an Agent popup box displays. You will search in the system for the
agent. You may search for an agent by first and last name or by email.
Searching for an Agent
1. Populate the First Name and Last Name fields
or
Populate the Email field with the desired agent’s information.
2. Click
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-33
If there are matches to the search, ExpressPAth displays the search results
beneath the search criteria.
3. Click on the hyperlink of the agent’s name.
If the agent is already associated to you, the message “Agent Already
associated with Physician” displays.
The agent must be registered and associated to at least one other provider in
ExpressPAth in order for the agent to return in the search results. Otherwise,
the following message displays.
Settings - Managing Your Profile Information - Providers
2-34 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
If the searched-for agent is not associated to the provider and has registered as
an agent for any other provider in ExpressPAth Provider Portal, the agent will
be included in the search results.
When the agent has been selected by clicking on the hyperlink with their
name in the search results, the Assign Privileges to Agent pop-up box
displays.
4. To assign privileges to the agent, click the checkboxes to select the desired
privileges.
5. To confirm the assignment of privileges, click
or
To cancel the assignment, click
A message displays, indicating the Agent’s record has been updated.
ExpressPAth adds the selected agent to your My Agents list.
A confirmation email is sent to the agent’s registered email, containing login
instructions.
Note: Agents receive emails to inform them that they have been activated by
their providers and that they are now able to perform assigned prior
authorization privileges on their behalf.
Note: Agents with Office Manager privileges are able to manage their
providers’ My Agents settings. Office Managers have the ability to
add agents, as well as edit their privileges, or deactivate agents on
behalf of their associated providers.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-35
Editing My Agents
You are able to edit privileges assigned to agents, to change the agent’s status, and to
amend the period of privileges.
1. Click on the Settings tab.
The Settings page displays with the Your Options menu open.
2. Click the My Agents link.
or
Next to My Agents click
The My Agents page displays in the work area.
Settings - Managing Your Profile Information - Providers
2-36 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
4. Locate the agent for whom edits are required.
5. Click the associated Edit link.
The My Agent (Edit Agent Information) page displays in the work area.
6. To edit the agent’s privileges, click the Assign Privileges checkboxes to
select or deselect privileges.
7. To edit the agent’s status, click the Agent status dropdown arrow.
If you are changing agent status from “Inactive” to “Active,” you must also
assign at least one privilege to the agent before you are able to save the edits.
8. To edit the dates in the Deactivate Agent on field, click the calendar
or
Type the amended date in the Deactivate Agent on field (MM/DD/CCYY).
Note: In order to deactivate an agent immediately, the Provider must choose
a date prior to the current date in the Deactivate Agent On date field.
An agent can also be deactivated on any date in the future by selecting
that date. When that date arrives, the agent’s status will automatically
be changed to “Inactive” in ExpressPAth.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-37
9. To save your edits, click
Note: If you assign the Office Manager privilege to more than three users,
subsequent office manager assignments will prompt a popup to
display. The popup indicates that at least three office managers have
been assigned and asks if you are sure you want to assign another.
10. To proceed, click
ExpressPAth saves the privileges. .
Authorizing an Agent Request
When an agent has registered and associated themselves to the prescriber, the
prescriber receives email notification.
To authorize the agent:
1. Open the Agent Activation email.
2. Click the link embedded in the email
or
Copy and paste the URL address string into your internet browser address
bar, and then click the Search icon.
Settings - Managing Your Profile Information - Providers
2-38 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
ExpressPAth displays the login screen.
3. Log into ExpressPAth.
The My Agent (Edit Agent Information) page displays.
3. Set the Agent Status field to Active.
Other Agent information fields become available.
The Start Date default is today’s date.
4. To change the start date, in the Start Date field type the start date in the
following format: MM/DD/YYYY
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-39
5. In the Deactivate Agent on field, change the date from today’s date to any
date in the future. If you wish to make this agent active until you manually
deactivate them, type in 12/31/2099 in this field.
7. In the Assign Privileges area, select all of the privileges you want to apply to
this agent.
8. When all of the desired check boxes are populated, click the button
A pop-up confirmation message displays and an email is sent to the Agent to
notify them that they are now able to perform Prior Authorization tasks on
behalf of the prescriber/provider.
Note: The prescriber/provider’s account must have been validated and
activated in order for the agent to perform PA tasks for that
prescriber/provider.
The My Agent page redisplays with the changes displayed.
Settings - Managing Your Profile Information - Agents
2-40 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Settings - Managing Your Profile Information - Agents
By accessing the Settings Tab in ExpressPAth, you are able to manage your profile
information, including editing your information and changing your password. Agents
are able to request association to additional providers/providing facilities, remove
association to providers/providing facilities and view other agents associated to their
providers/providing facilities.
My Information (Agents)
Agents are able to edit and update their settings in the ExpressPAth Provider
Portal.
To edit or update My Information:
1. When you have logged into ExpressPAth, click on the Settings tab.
On the left side of the page, a list of Your Options displays.
2. To edit your information, click the My Information hyperlink
or
Next to My Information, click
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-41
You are able to edit the following fields: all Name fields, Email, Secret
Question, or Answer. You can also change your password here.
3. Click the desired field and type the updated information in the desired field.
5. When you are finished, click
E-mail Summary
To disable email notifications, place a check in the box next to the
box
or
If you do not opt out, you will receive an email every day that there is activity
in any of the listed categories for PA’s that you are associated with:
LOW: You will receive a daily summary showing a total of all approvals,
denials, withdrawals, or PA’s requiring further information for that day.
MEDIUM (default): In addition to receiving low notification emails, you
will get an email each time a PA that you intiated (or a PA that you are
associated with) requires further information for you to enter/submit.
HIGH: In addition to receiving low and medium notifications, you will get
an email notification each time a PA you intiate or are associated with is
approved, denied, or withdrawn.
Settings - Managing Your Profile Information - Agents
2-42 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
My Physicians (for Agents)
My Physicians is a repository for providers to whom you are associated.
To view My Physicians information:
1. Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
2. Click on the My Physicians link.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-43
A list of physicians associated to the agent displays.
Adding My Physicians
To add physicians to your My Physicians list:
1. Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
Settings - Managing Your Profile Information - Agents
2-44 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
2. Click on the My Physicians link.
A list of physicians or providing facilities to whom you are associated
displays.
3. Click the Add link.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-45
The “Search for an existing Physician” pop up box displays.
There are four ways to search for a physician or providing facility.
Note: The physician or providing facility must have already registered for
ExpressPAth Provider Portal in order to display in the search results. They do
not have to be activated yet.
To search for a physician or providing facility by NPI number:
1. In the Physician NPI field, type the physician’s or providing facility’s NPI
number.
2. Click
To search for a physician by name:
1. In the First Name field, type the first name of the physician.
2. In the Last Name field, type the last name of the physician.
3. Click
To search for a providing facility by name:
1. In the Facility Name field, type the providing facility’s name.
2. Click
To search for a physician by PPI number:
Settings - Managing Your Profile Information - Agents
2-46 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
1. In the PPI field, type the ExpressPAth ID number that was assigned to the
provider during their registration.
2. Click Search results, if any, display beneath the search area.
If the desired physician or providing facility displays in the search results
area, to select the physician or providing facility:
1. Click on the Prescriber Name, which is a link.
You will use the Prescriber Name link even if you are selecting a Facility. If
no name is associated to the Facility, it will say “Unknown, Unknown” in the
Prescriber Name field.
2. The system adds the physician or providing facility to your My Physicians
list.
Note: An email is sent to the Physician or Providing Facility to inform them
that an Agent has requested association to them. The provider must
assign privileges and activate the agent through a link included in the
email before the Agent is able to perform prior authorization tasks on
their behalf.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-47
Reminder to Activate
If a provider does not activate the agent in a timely manner, the agent is able to send an
email reminder requesting that the provider complete the activation.
To send a reminder to the physician to activate the agent:
1. In ExpressPAth, click on the Settings tab.
The Settings tab menu displays.
2. On the Settings tab menu, click the My Physicians link.
The physician or physicians to whom you have requested association display.
3. Locate the physician who has not activated.
Note: Agent Status will be “InActive.”
4. Click the Send Reminder to Activate link.
Settings - Managing Your Profile Information - Agents
2-48 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
A message displays, indicating that a reminder has been sent.
5. If the physician does not activate the agent in a few days, the agent can click
the “Send Reminder to Activate” link again and another email will be sent.
Disassociating from a Provider on your My Physicians List (Agent)
An agent who is associated to a provider is able to disassociate him/herself from the
provider by removing the physician from their My Physicians List.
As an Agent, to remove association from a provider:
1. On the ExpressPAth Provider Portal Home page, click the Settings tab.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-49
2. The Settings page displays in the work area with the Account Home menu
open.
3. Click the My Physicians link.
The My Physician page displays.
Note: The system will display all Providers to which the Agent has
requested an association, even if they have not been activated yet.
The Agent has the ability to remove association for any provider listed
here.
4. For the desired physician, click the Remove link.
Settings - Managing Your Profile Information - Agents
2-50 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
A pop-up message displays, asking, “Do you want to remove this Physician?”
5. To continue removing the physician, click Yes.
A second pop-up message displays, stating, “Physician disassociated
successfully.”
6. Click OK.
Your My Physicians list redisplays. The disassociated physician is no longer
listed.
Note: When an Agent removes a Provider from their My Physicians list, an
e-mail is sent to the Provider.
Note: Once an Agent has disassociated from a provider, that Agent is no
longer able to perform prior authorization tasks on the provider’s
behalf.
An Agent may remove association to all providers, but they will not
be able to perform any prior authorization tasks in the ExpressPAth
Provider Portal once all associations are removed.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-51
My Physician Agents (for Agents)
Viewing My Physician Agents
Physician Agents are other agents that an Agent’s physicians or providing facilities are
associated with in ExpressPAth. These other agents are also authorized to perform
specific prior authorization tasks on behalf of that physician or providing facility.
1. Click on the Settings tab.
The Settings Home page opens, with the Settings menu displayed.
Settings - Managing Your Profile Information - Agents
2-52 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
2. Click on the My Physician Agents link.
A list of Physician Agents to whom your physicians or providing facilities are
associated displays.
If your physician or providing facility is not associated to any other agents,
the message “No Registered Agents available” displays.
No action may be taken on this page.
Note: Agents with Office Manager privileges will see both a My Physicians
link for all of their associated providers and/or providing facilities, as
well as a My Agents link for all other agents that are also associated
to their providers/providing facilities.
3. To return to the Settings menu, click the Settings tab.
or
To exit ExpressPAth, click the Logout tab.
or
To manage your prior authorizations, click the Prior Authorizations tab.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-53
Creating a List of Favorite Rendering Providers (Providers and Agents)
In the ExpressPAth Provider Portal, you are able to create a list of up to twenty favorite
rendering providers, making it easier to select frequently used providers. Favorite
Rendering Providers may be added manually or by searching. They may also be edited
or removed.
Viewing Your Favorites
1. Log into ExpressPAth.
2. Click on the Settings tab.
Creating a List of Favorite Rendering Providers (Providers and Agents)
2-54 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The Settings page opens in the work area.
3. Click the My Favorite Rendering Providers link.
The My Favorite Rendering Providers summary page displays with your
current favorite providers, if any.
My Favorite Rendering Providers
To create your own list of favorite rendering providers, you will first need to search for
existing providers. If you are unable to locate the provider after searching, you will
need to add the provider. You are also able to edit rendering provider information.
Because there is a limit of twenty favorite providers, if you exceed your limit and want
to add a new rendering provider to your favorites, you will need to remove a provider
first and then add the new provider.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-55
Searching for Favorite Rendering Providers
1. Click on the Settings tab.
The Settings page opens in the work area, with the Settings menu open.
2. Click the My Favorite Rendering Providers link.
Creating a List of Favorite Rendering Providers (Providers and Agents)
2-56 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The Search Rendering Provider page displays.
If you have no favorite rendering providers listed or if you want to add
another favorite provider to your list, start your search by locating providers
already in the system.
3. Click Search.
The Search Rendering Provider form pops up.
There are three ways to search for a rendering provider.
To search for a rendering provider by NPI number:
1. In the NPI field, type the rendering provider’s NPI number.
2. Click
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-57
To search for a rendering provider by Facility Name:
1. In the Facility Name field, type the name of the facility.
2. Click
To search for a rendering provider by name:
1. In the First Name field, type the first name of the provider.
2. In the Last Name field, type the last name of the provider.
3. Click
The Search results display beneath the search criteria area.
4. If the desired prescriber/provider displays, in the Provider Name field, click
the provider’s name. This is a hyperlink.
Creating a List of Favorite Rendering Providers (Providers and Agents)
2-58 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The selected provider displays as one of your favorite rendering providers.
5. If the desired provider does not display, click
You will need to manually add the provider.
Note: Favorite Providers do NOT have to be registered in ExpressPAth.
Adding a Favorite Rendering Provider
If a favorite rendering provider is not located by searching, you are able to manually
add the rendering provider.
To add a Favorite Rendering Provider:
1. On the My Favorite Rendering Providers home page, click Add.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-59
The Add new Rendering Provider pop-up displays.
2. You must populate the mandatory fields indicated by a red asterisk (*) to
manually add a rendering provider.
Mandatory fields include:
NPI
First Name
Last Name
Address Line 1
City
State
Zip
Work Phone
Email Address
Specialty (Note: Selecting the Specialty automatically populates the
Taxonomy Code field)
Taxonomy Code (Note: Entering the Taxonomy Code automatically
populates the Specialty field)
3. You may also populate the Facility Name, Address Line 2 and Fax Number
fields (optional).
4. Click
The provider is added to your favorites.
Creating a List of Favorite Rendering Providers (Providers and Agents)
2-60 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
Editing a Favorite Rendering Provider
If any of the information for a retrieved provider needs to be updated, you will need
to edit it.
To edit the information for an existing provider
1. Locate the provider on your Favorite Rendering Provider list and click the
Edit link.
The Edit Rendering Provider popup displays, with the selected provider’s
information.
2. Update the provider’s information.
3. Click
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-61
Removing a Rendering Provider
If you are attempting to add a rendering provider to your favorites, but you are
already at your maximum of twenty favorites, a popup displays. It states, “The
maximum number of Favorites has been reached. Only 20 Favorites may be
designated.”
To remove the popup, click
Note: You will need to remove a rendering provider from your existing
Favorites before you will be able to add another rendering provider
to your Favorites list.
Note: You are able to remove rendering providers from your Favorites list
at any time, regardless of whether you have reached your limit of
twenty favorite rendering providers.
To remove a provider from your favorites:
1. On your list of My Favorite Rendering Providers, locate the provider to be
removed.
Creating a List of Favorite Rendering Providers (Providers and Agents)
2-62 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
2. Click the Remove link.
A popup displays, stating: “Do you want to delete this provider from your
Favorites?”
3. To remove the favorite provider from your favorites list, click
or
To keep the favorite provider on your favorites list, click
Once you click Yes, the provider is removed from your list of Favorite
Rendering Providers.
You are now able to add an additional provider to your favorites.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-63
Changing Your Password (Providers and Agents)
To view or edit your password information:
1. Click on the Settings tab.
The Settings page opens in the work area. (Shown is Provider view.)
2. Click the My Information link.
or
Click My Information
The My Information page displays.
Changing Your Password (Providers and Agents)
2-64 Provider Portal User Guide
Client Application Training Department
© Express Scripts, Inc.
09/13/2011
The example shown below is for a provider.
The example shown below is for an agent.
3. Click the Change Password link.
The Change Password page displays.
Section 2―Provider Portal Registration
09/13/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
2-65
4. In the Old Password field, type your old password.
5. In the New Password field, type your new password.
Note: Your password must be at least six characters long. It cannot match
any of the five previous passwords used. It must contain at least:
One upper case alpha character
One lower case alpha character
One number
One special character
6. In the Retype New Password field, retype your new password.
7. Click
The Change Password confirmation popup displays.
8. To exit the popup and confirm the password change, click
Note: Changing the password and changing the secret question/answer are
the only My Information fields that an Agent with Office Manager
privileges is not able to manage for their providers.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-1
Initiating a Prior Authorization Request
Step 1: Search for Patient ..............................................................................3-3
Step 2: Select Patient .....................................................................................3-7
Step 3: Search for Drugs/Services ................................................................3-9
a. Drug Search .....................................................................................3-9
b. Service Search .................................................................................. 3-11
Step 4: Step Therapy Alternatives .................................................................3-12
Step 5: Additional Information.......................................................................3-14
a. Template for Drug Covered Under Medical Benefit.......................3-14
b. Template for Drug Covered Under Pharmacy Benefit....................3-16
c. Educational/Recommended Alternatives .......................................3-17
d. Drugs with Multiple Durations .......................................................3-18
Step 6: Select a Site of Care ...........................................................................3-20
a. Benefit Type ....................................................................................3-20
b. Site of Care ......................................................................................3-21
Step 7: Verify Prescribing Physician or Nurse Practitioner .........................3-21
a. Prescriber View ................................................................................3-22
b. Prescriber’s Agent View ..................................................................3-23
c. Provider/Providing Facility/Provider Agent View...........................3-23
Step 8: Select Rendering Provider .................................................................3-25
a. Add/Search for a New Provider .......................................................3-25
b. Pick from Favorite Rendering Provider List ...................................3-26
c. Lowest Cost Vial Selection ..............................................................3-31
d. Requesting Associated Service Prior Authorizations ......................3-31
e. Duplicate Prior Authorization Notification .....................................3-32
Step 9: Complete Questionnaire ....................................................................3-33
a. Printing clinical questionnaire .........................................................3-35
Step 10: Attach Supporting Documents.........................................................3-36
a. Barcoded fax cover sheet .................................................................3-38
Step 11: Review Submitted ...........................................................................3-39
Complete an existing Prior Authorization Request
a. Get Next PA in Queue ....................................................................3-42
Search for a Previously Submitted Prior Authorization Request
a. To Search for a previously submitted PA .....................................3-44
b. Withdraw a PA ..............................................................................3-47
c. Copy & Update PA ........................................................................3-49
d. Appeal ............................................................................................3-50
Contents
3-2 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
10/7/2011
Initiating a Prior Authorization Renewal
Step 1: Search for a Prior Authorization eligible for renewal ......................3-52
Step 2: Initiate Renewal .................................................................................3-53
Updating Rendering Provider NPI
a. From an email link ...........................................................................3-56
b. Editing the Provider .........................................................................3-57
c. Picking from Favorites ....................................................................3-59
Searching for a Rendering Provider ...............................................................3-61
Adding a New Provider ...................................................................................3-63
Updating Rendering Provider from a Prior Approval ....................................3-64
Blue Cross Blue Shield of Massachusetts (BCBSMA) Providers ONLY
Step 1: Search for Patient ..............................................................................3-66
Step 2: Select Patient .....................................................................................3-67
Step 3: Search and Select drugs or ancillary services ......................................3-68
a. Search for specific drug by NDC, Drug Name, HCPCS/CPT code.....3-70
Step 4: Formulary/Preferred Alternatives ........................................................3-74
Step 5: Additional Information .......................................................................3-74
a. Select Drug/ Service section ...............................................................3-75
Step 6: Select a Dispensing Location ……………………………………….3-77
Step 7: Verify Prescribing Physician or Nurse Practitioner ............................3-78
Step 8: Select the Rendering Provider ............................................................3-80
a. Duplicate Prior Authorizations- Medical Benefit.................................3-81
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-3
Initiating a Prior Authorization Request
To begin initiating a new prior authorization:
1. Log into ExpressPAth.
2. Click on the Initiate a new Prior Authorization request link
or
Click the Go button for ―Initiate a new Prior Authorization request‖ from
the Home page.
Initiating a Prior Authorization Request
3-4 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
There are ten steps to initiate a new prior authorization request for a
drug/service covered under the medical benefit (only ten steps for a drug
covered under the pharmacy benefit. These steps display on the left side of
the page.
Initiating a Prior Authorization Request
3-6 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The Step 1: Search for a Patient form displays in the work area. On the left side of
the page, your initiation progress is tracked.
1. To view available health plan choices, click the Select Insurance dropdown arrow.
2. To select the patient’s health plan from those displayed on the Insurance List dropdown,
click on the desired health plan. This is a required field.
You may locate the patient one of two ways: Member ID or Name and Date of Birth.
To locate a patient by member ID:
In the Member ID field, type the member ID found on the patient’s insurance card.
Note: Depending on the health plan, you may need to search by the pharmacy benefit
member ID, medical benefit member ID, or either the pharmacy or medical
member ID.
To locate a patient by name (First Name, Last Name and Date of Birth are all required name
search fields.):
1. In the Last Name field, type the patient’s last name. Press Tab.
2. In the First Name field, type the patient’s first name. (The first three letters of the
patient’s first name are required, unless their first name is only two letters). Press Tab.
Next to the Date of Birth Field, the Calendar feature becomes available.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-7
3. Select the appropriate date from the Calendar feature
or
To bypass the calendar, press Tab again.
4. In the Date of Birth field, type the birth date of the patient as MM/DD/YYYY.
Note: You do not need to enter separators. ExpressPAth will supply the separator
between date fields for you.
5. Click Step 2: Patient Search Results displays in the work area.
Initiating a Prior Authorization Request
3-8 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
1. Confirm that the patient has active Pharmacy and/or Medical Eligibility (depending on
the health plan).
If the patient does not have active Pharmacy or Medical Eligibility (depending on the
health plan), do not proceed. Contact the health plan to confirm eligibility.
2. If the patient has Pharmacy and/or Medical Eligibility Status of Eligible (depending on
the health plan), click on the patient’s name, which is a hyperlink.
Note: Some patients may be covered by multiple groups under the same health plan. If
the Coverage/Group Number field says ―Select‖ in the dropdown, you will need to select
the appropriate group coverage as well before clicking on the hyperlink of the patient’s
name.
Note: When searching for a patient by Member ID, an entire family may appear in Step
2: Patient Search Results. Make sure that you scroll down, if necessary, and select the
appropriate patient by clicking on the hyperlink with the patient’s name before
proceeding.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-9
Step 3: Search and select drugs or ancillary services displays.
1. In the Search for Drug by NDC, Drug Name or HCPCS/CPT Code section, in the
appropriate fields type the desired drug NDC number, Drug Name, or HCPCS/CPT code.
Note: Only one drug or service may be entered on a Prior Authorization at a time.
Definition: HCPCS Codes, Healthcare Common Procedure Coding System numbers, are the
codes used by Medicare and monitored by CMS, the Centers for Medicare and Medicaid
Services. They are based on the CPT codes (Current Procedural Technology codes)
developed by the American Medical Association. HCPCS Codes are numbers assigned to
every task and service a medical practitioner may provide to a Medicare patient including
medical, surgical and diagnostic services. There are two sets of codes. The first set, HCPCS
Level I, are based on and identical to CPT codes. Level II HCPCS codes are used by medical
suppliers other than physicians, such as ambulance services or durable medical equipment.
Definition: CPT Codes are numbers assigned to every task and service a medical practitioner
may provide to a patient including medical, surgical and diagnostic services. They are then
used by insurers to determine the amount of reimbursement that a practitioner will receive by
an insurer. CPT codes are developed, maintained and copyrighted by the AMA (American
Medical Association). As the practice of healthcare changes, new codes are developed for new
services, current codes may be revised and old, unused codes are discarded. These codes are
updated annually.
Initiating a Prior Authorization Request
3-10 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
To search for the desired drug NDC:
1. In the NDC field, type the NDC of the drug, Click Search.
To search for a drug by Drug Name:
1. In the Drug Name field, type the name of the drug, Click Search
To search by HCPCS/CPT code:
1. In the HCPCS/CPT code field, type the HCPCS/CPT code, Click Search.
The Search Results pop-up displays. The Search Results list every NDC available in both the
First Data Bank (FDB) and Medi-Span databases when a search is performed by drug name. If
you had performed the search by HCPCS/CPT or NDC, only those results would appear in the
pop-up.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-11
3. Click on the desired result, which is a hyperlink. (Shown above is the Drug Name link
result).
If this prior authorization request is for a stand-alone service, you will need to conduct a search in
the Search for Services section.
Definition: Ancillary services fall into three broad categories: Diagnostic, Therapeutic and
Custodial. They are located mainly in three types of facilities: hospitals, medical offices and
free-standing sites. States have regulations concerned with ancillary service providers and their
equipment. They determine what medical direction, consultation and supervision is necessary.
An ancillary service provider extends and facilitates the primary care provided by doctors and
nurses.
1. In the Search for Services section, click the Select a Service dropdown arrow to view
available services for the patient’s health plan.
2. Click to select the desired service option from those listed. Click the Add button. Click
Next to proceed.
Initiating a Prior Authorization Request
3-12 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The drug or service you selected displays. Click the Edit Drug hyperlink to make a
change. You will be taken back to the beginning of Step 3 and will need to enter a new
drug or service.
After the drug or service is selected, the Episode of Coverage (EOC) ID is created.
An EOC (Episode of Coverage) is the unique ID number generated by the ExpressPAth
Provider Portal when a user has entered the patient and drug information on a prior
authorization request.
At this point, the user can save the PA at any point and return to complete it, starting at
the step where they last left off within the prior authorization, within five business days.
Clicking Next will automatically save the prior authorization after each step is
completed as well.
If the selected health plan has step therapy in place, Step 4: Step Therapy Alternatives
displays.
Definition: Step Therapy is the practice of beginning medication for a medical condition with
the most cost-effective and safest drug therapy and progressing to other more costly or risky
therapies only if necessary.
While creating a PA, if the selected drug has a step therapy alternative, then the system
will display all the preferred drugs under the Step 4 Step Therapy Alternatives.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-13
1. The user will click on (one of) the preferred medication(s) and click Next
2. Click on the hyperlink to the appropriate NDC. The Search Results list every NDC
available in both the First DataBank (FDB) and Medi-Span databases.
3. The system will direct the User to the end of Step 3 (Search for Drugs/Services) with the
new preferred Step Therapy medication, Click Next.
Note: If the health plan does not have any step therapy alternatives available in ExpressPAth, this
step is skipped.
Initiating a Prior Authorization Request
3-14 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Step 5: Additional Information displays in the work area.
For drugs typically covered under the medical benefit and prescribed with a doctor’s
order, you will see a screen similar to the one below:
To complete Step 5: Additional Information for drugs typically covered under the medical
benefit (actual fields presented to the user may vary because it is based on the information that a
client requests for a drug):
1. Enter the Dosage. A drug dose is the specific amount of medication to be taken per the
frequency. Type the valid dosage in numeric format and select the applicable dosage
(mg, mcg, units, ml, etc.) from the dropdown.
2. Enter the Frequency. Frequency is the number of times a drug is given during a
specified timeframe. Type the valid frequency in numeric format and select the
applicable frequency (hour, week, day, month, year) from the dropdown.
3. The Duration is auto-calculated. Duration is the number of days that a prior
authorization is effective.
a. Example Doctor’s Order: Synagis 15 mg/kg every month for five months (10 kg
baby)
i. Dosage = 150 mg
ii. Frequency = 1 per month (every 28 days)
iii. Duration = 140 days (five months)
4. Quantity is a required field and will auto-calculate based on the information in the
Dosage, Frequency and Duration fields. Quantity refers to the number of NDC units
(e.g., vials, syringes, etc.) prescribed for the specific drug/dosage selected. The quantity
of NDC units will return the number needed for the entire duration.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-15
5. In the Route field, click the dropdown arrow to select the route of administration of the
drug. The default for this required field comes from Medi-Span. Medi-Span is a
leading provider of drug information, providing drug databases in a variety of formats,
including clinical decision support and disease suite modules. The Medi-Span internal
database is updated daily to include the latest additions and changes being reported by
the FDA, pharmaceutical manufacturers, as well as the latest research articles being
published. You can visit their website at https://medi-span.com/
6. Strength is not an editable field and is populated based on the drug NDC selected.
7. You can indicate whether the prior authorization request is a new or ongoing request in
the New/On-going field.
8. Package Size is not an editable field and is populated based on the drug NDC selected.
9. In the Start Date field, type the start date of service as MMDDYYYY or use the
calendar feature. The Start Date of Service defaults to the current date, but should be
changed to the first date of service, if necessary.
10. The End Date is auto-calculated based on the duration of the prior authorization request.
Editing the end date changes the duration and vice versa.
11. Some ExpressPAth clients (health plans) use our measurement based dosing feature,
which allows them to display a message to the user if the dosage is not appropriate based
on the weight of the patient. The following message will display:
If the drug requires measurement-based dosing, the Patient’s Weight field will appear and
will be a required field. If necessary, type the Patient’s Weight in the Weight field. You
can either enter the weight in Lbs/Oz or in Kgs. Select the method of entry from the
dropdown.
12. The Patient’s Age is auto-populated from the member’s date of birth.
13. Waste Quantity is the portion of a vial that a physician must waste (throw away) after
delivering medication to a patient. This is typically not a required field.
14. Direction is equivalent to the sig line on a prescription or doctor’s order.
15. The Urgency flag can be used to indicate whether a prior authorization request needs
attention faster than the health plan’s standard turnaround time.
In addition to the fields typically visible on the Additional Information screen listed above,
certain drugs may require other information, such as:
Patient’s Height – information can be entered in either feet/inches or centimeters.
Choose the method of entry from the dropdown.
CrCl Level – the volume of blood plasma that is cleared of creatinine per unit time and is
a useful measure for approximating the GFR (Glomerular Filtration Rate), which
describes the flow rate of filtered fluid through the kidney.
Initiating a Prior Authorization Request
3-16 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Body Surface Area- This is a calculated field derived by what has been entered for
the member’s height and weight.
For drugs typically covered under the pharmacy benefit and written as a prescription, you will see
a screen similar to the one below:
To complete Step 5: Additional Information for drugs typically covered under the pharmacy
benefit:
1. Quantity is a required field and refers to the number of NDC units prescribed
for the specific drug/dosage selected.
2. Day’s Supply is a required field and is the number of days that the patient
should take their prescription based on the Quantity prescribed and Direction.
3. No of Refills is the number of refills being requested. If no refills are
authorized, enter zero in this field.
4. Duration will auto-calculate based on the Day’s Supply and No of Refills.
5. In the Start Date field, type the start date as MMDDYYYY or use the calendar
feature. The Start Date of Service defaults to the current date, but should be
changed to the first date that the patient should take the drug, if necessary.
6. The End Date is auto-calculated based on the duration of the prior
authorization request, Editing the end date changes the duration and vice versa.
7. In the Route field, click the dropdown arrow to select the route of
administration of the drug. The default for this required field comes from
Medi-Span. Medi-Span is a leading provider of drug information, providing
drug databases in a variety of formats, including clinical decision support and
disease suite modules. The Medi-Span internal database is updated daily to
include the latest additions and changes being reported by the FDA,
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-17
pharmaceutical manufacturers as well as the latest research articles being
published. You can visit their website at https://medi-span.com/
8. Indicate whether the prior authorization request is a new or ongoing request in
the New/On-going field.
9. Direction is equivalent to the sig line on a prescription or doctor’s order.
10. The Urgency flag can be used to indicate whether a prior authorization request
needs attention faster than the health plan’s standard turnaround time.
Click
Educational/ Recommended Alternative-is a general recommendation to switch to an
alternative therapy that is clinically supported. However, not choosing the
educational/recommended alternative would not result in a Denial.
When a PA is being created for a drug that has an Educational/ Recommended
Alternative, the Alternatives will be displayed at the bottom of the Additional Information
Screen.
1. User will select the preferred Educational/ Recommended Alternative by clicking on the
hyperlink for the drug/dosage and Click Next.
Initiating a Prior Authorization Request
3-18 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
2. Click on the appropriate NDC. The Search Results list every NDC available in both the
First Data Bank (FDB) and Medi-Span databases.
3. The system will direct the user back to the end of Step 3 Search for Drugs/Services
screen with the new preferred Educational/ Recommended Alternative medication listed.
Click Next.
4. The system will return the User to the Step 5 Additional Information screen with the new
Educational/ Recommended Alternative medication in place.
5. Complete the Step 5 process again for the educational/recommended drug and Click
Next.
Multiple Durations- Some drugs that are reviewed in Express PAth will have the ability to enter
multiple durations in the additional information screen. This capability allows a user to enter
different dose, frequency and duration combination on a single PA for a single drug. This
functionality allows for situations where a loading dose is required or where the standard course
of treatment includes different doses based on a standardized interval.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-19
Based on the Drug Selected and Diagnosis code entered in Step 3, the Multiple Durations
display will populate in the Step 5 Additional Information Tab.
1. Enter Frequency- (frequency is the number of times a drug is given during a specified
timeframe). Type the valid frequency in numeric format.
2. Select the applicable Frequency in the dropdown box.
Example: Doctor’s Order: Synagis 15 mg/kg every month for five months
(10 kg infant)
I. Dosage= 150 mg
II. Frequency= 1 per month (every 28 days)
III. Duration= 140 days (five months)
3. Enter the Dosage- (the specific amount of medication to take per frequency). The dosage
should be based on the frequency requested not the duration requested. Type the valid dosage in
numeric format.
4. Select the applicable Dosage type in the dropdown box.
Example: If the patient is to be given 150 mg every 28 days, ―150 mg‖ is the
dosage that should be entered.
Initiating a Prior Authorization Request
3-20 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
5. Enter the Start and End Date for each Duration on the screen. Durations cannot have
overlapping date spans and the application will not allow the Dosage and Frequency to be equal
for consecutive durations.
6. If the Multiple Duration section requests the patient’s weight, please fill out appropriately.
7. Click Next Step to submit the Multiple Duration information.
Step 6: Select a Site of Care displays. You must select the benefit type and site of care where
the drug will be administered from the dropdown.
To select a Benefit Type:
1. In the Benefit Type field, click the dropdown arrow.
2. Select the appropriate Benefit Type. The field requires the selection of either
Pharmacy of Medical benefit. If the member has one Benefit Type (ex: medical),
only that benefit will populate in the field.
Once the Benefit Type has been selected, the Site of Care will populate.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-21
To select the Site of Care:
1. In the Site of Care field, click the dropdown arrow.
If the Pharmacy Benefit is chosen, Retail Pharmacy will be displayed in the Site of
Care Field.
If the Medical Benefit is chosen, Site of Care location values will be displayed in the
Site of Care Field.
2. Select the appropriate Site of Care, Click Next.
Step 7: Verify Prescribing Physician or Nurse Practitioner displays in the work area.
The Prescribing Physician is a person who is licensed to write a prescription for a drug
or service (e.g. Physician, Nurse Practitioner, Physician's Assistant or a Pharmacist). For
the purpose of the PA request, this is the physician that prescribed the medication that is
being requested.
Initiating a Prior Authorization Request
3-22 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
There are several ways to populate Step 7: Verify Prescribing Physician or Nurse
Practitioner.
Prescribing Physician View
If you are logged in as the prescribing physician, your primary practice location information will
automatically appear on this screen. Simply click on this screen if none of the information
has changed. (If you need to permanently change any of the information on this screen, you must
change your profile preferences under the Settings tab.)
To select a different prescribing location than your primary (default) practice location:
1. Click the Select different location of Prescriber dropdown.
2. From the list of associated locations, click on the desired prescriber location to select it.
3. Click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-23
If you are logged in as an agent of a prescriber, select the appropriate prescriber/practice location
from the dropdown. If the agent is not the prescriber or associated to the prescriber, the email
address is not required. Simply click on this screen if none of the information has changed.
(Your prescriber or his/her associated agent with an Office Manager role can permanently change
any of the information on this screen by updating the prescriber’s profile preferences under the
Settings tab.)
Provider/Providing Facility or Provider/Providing Facility Agent View
Prescribing Agent View
Initiating a Prior Authorization Request
3-24 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
If you are logged in as a provider, providing facility or one of their designated agents, you have a
few options on this screen.
To manually enter details for the prescriber, click the Add Prescriber link:
1. In the NPI field, type the physician’s NPI number.
The National Provider Identifier (NPI) is a unique identification number for health care
providers issued by the National Plan & Provider Enumeration System (NPPES) that
will be used by all health plans. NPIs are issued to health care providers in order to
submit claims or conduct other transactions specified by HIPAA. Click on the link
below to view/update the NPI or to request a new NPI.
https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
Note: The State License ID and DEA fields are optional.
2. In the Taxonomy Code field, type the physician’s taxonomy code number
or
Select the physician’s Specialty from the dropdown list. Once the Specialty or the
Taxonomy Code is selected, the other field auto-populates.
The Health Care Provider Taxonomy codes are national specialty codes used by
providers to identify their specialty category. The codes are created by the National
Uniform Claim Committee (NUCC), which is chaired by the American Medical
Association. Click on the link below to obtain the list of taxonomy codes and to identify
the correct code to use for your specialty.
http://www.nucc.org/index.php?option=com_wrapper&Itemid=50
3. In the First Name field, type the physician’s first name.
Note: The Prefix and Middle Initial fields are optional.
4. In the Last Name field, type the physician’s last name.
5. In the Address Line 1, City, State, and Zip fields, type the physician’s address.
Note: Address Line 2 is optional.
6. In the Work Phone field, type the 10-digit phone number.
Note: Fax information is optional, but should be entered if possible so that the health
plan can fax prior authorization request notifications to the prescriber.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-25
7. In the Enter your Email Address field, type your email address. If you don’t know the
prescriber’s email address, enter a dummy email address here: [email protected].
8. In the Retype Email Address field, type your email address again. The two email
addresses must match.
9. To save the changes, click
10. To continue to the next step, click
Step 8: Select/Change/Edit Rendering Provider displays in the work area.
A Rendering Provider is any person or facility that is licensed to administer a drug or
service (e.g. Physician’s Office, Home Infusion Therapy Agency, Specialty Pharmacy,
Outpatient Facility or a Dialysis Center). For the purpose of the PA request, this is the
facility that will be administering the drug or service requested in the prior authorization
for a drug covered under the medical benefit.
Initiating a Prior Authorization Request
3-26 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The Select/Change/Edit Rendering Provider page determines if this request will be
submitted using the prescriber’s NPI or using a different NPI.
In the Options section there are several options:
Leave the provider as listed (using the prescriber’s NPI)
Select a different location for the prescriber
Search for a different provider
If the provider is not available by search, Add a new provider
Pick a provider from your Favorites List
To use the prescriber’s NPI and primary location to submit this claim, click
To select a different location for the prescriber, click the radio button Select Different Location
and choose the alternate location from the dropdown that appears.
Picking a different Rendering Provider
To use a different NPI number to submit this claim:
1. In the Options section, select the Add/Search for a different Provider radio button.
2. The Add Provider and Search Provider links become available.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-27
To Search for a different rendering provider:
1. Click
The Search Rendering Provider form displays at the bottom of the work area.
2. Search for an existing rendering provider one of three ways:
By NPI number,
or
By First Name and Last Name,
or
By Facility Name
3. When you have populated the desired fields, click
Initiating a Prior Authorization Request
3-28 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
A list of providers matching your search displays in the blue section of the form. A
provider does not have to be registered to use ExpressPAth to be found – most providers that are
registered with CMS should pull in the search results.
4. Scroll to the desired provider, then click the Provider Name link.
The rendering provider’s information displays in the Rendering Provider Details
section.
5. To submit this provider as the rendering provider, click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-29
To Add a new provider and use this provider as the rendering provider:
1. Click the Add Provider hyperlink.
The Add new Rendering Provider form displays at the bottom of the page
2. In the NPI field, type the provider’s NPI number.
3. Click the Specialty field dropdown to select the provider’s specialty. Selecting the
Specialty will auto-populate the Taxonomy Code field.
a. or
b. In the Taxonomy Code field, type the provider’s taxonomy code number. This
will auto-populate the Specialty field.
4. The Facility Name field is optional.
5. The First Name, Last Name, Address Line 1, City, State, Zip, and Work Phone
number fields are required and must be populated.
6. The Prefix, Address Line 2, Fax #1 and Fax #2 fields are optional; however, a fax
number should be entered in the Fax #1 field, if possible, so that prior authorization
notifications can be sent from the health plan to the provider.
Initiating a Prior Authorization Request
3-30 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
7. In the Enter your Email Address field, type the provider’s email address. If you don’t
know the provider’s email address, type in a dummy email address: [email protected]. If
you are not the prescriber or not associated to the prescriber, the email address is not
required.
8. In the Retype Email Address field, type the provider’s email address again. The two
email addresses must match.
9. When finished, click
You can add any provider to your list of favorite rendering providers by simply clicking on the
checkbox at the bottom of the screen on Step 8
Up to twenty favorite rendering providers can be saved in your profile.
To select a different rendering provider from your list of Favorites:
1. Click the Pick Provider from Favorites List radio button.
2. A dropdown selection box displays to the right of this choice.
3. To view the favorites, click the dropdown arrow.
4. If providers on your favorites list are available to be rendering providers for this patient,
they will display on the list.
5. Click the provider to select it.
6. To submit this provider as the rendering provider, click
Step 8: Select Rendering Provider redisplays, with your provider’s information in the
detail section.
7. To submit this provider as the rendering provider, click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-31
Lowest Cost Vial- a service that replaces the requested Drug (NDC) with the most cost
effective UM Managed NDC. Users are able to choose the Lowest Cost Vial or opt out of
the recommended drug.
The Lowest Cost Vial functionality can be enabled by a health plan – it is not
presented to the user unless the health plan requests the user to choose the lowest cost
vial health plan
If a drug has the Lowest Cost Vial option for a health plan, the following message will appear
after the user Clicks Next Step in Step 8: Lowest Cost Vial (Click on the radio button to
select any lowest cost vial).
If the User’s original request is for the Lowest Cost Vial already, the pop-up will not
populate.
1. User will click on the appropriate Radio Button and Click Next
2. If the Pop-up box displays more than one option, the User must choose an option
and Click Next.
Once the drug is chosen and the user Clicks Next, the system will direct to Step 9
Complete the Questionnaire.
Drug/ Service Association: ExpressPAth can associate a set of services with a drug and
automatically create related prior authorizations for each of the services that have been associated
to that drug. A list of drugs and possible related services are configured into ExpressPAth by a
health plan. If the user has requested a drug that has services available, the following steps will
occur.
Initiating a Prior Authorization Request
3-32 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
1. User will click the Next Step button to submit Step 8 and will receive the following
message:
The following ancillary service(s) will be requested upon submitting this PA.
Please enter a quantity if applicable and make a choice if more than one option
exists.
User will enter the correct quantity and select the correct Service Set Radio button
More than one Service may populate, please choose the appropriate set
Quantity is a required field and will default to 1, if not entered.
2. Click Save and the system will direct User to Step 9.
Duplicate Error Message: will populate when the Portal User is creating an EOC under the
Medical Benefit for a Prior Authorization that already exists. The message will appear if the User
is creating an EOC with the same Patient, Drug, Provider and overlapping time periods.
1. User will submit information in Step 8 by clicking Next Step, the following error message
will populate: ―You are attempting to create a PA for a patient, drug, and provider that
already exists.‖
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-33
2. Click View to view the existing PA.
3. Click Ok to exit out of the message and discontinue the request.
Step 9: Complete all the sections in the form below displays in the work area
Click the Answer hyperlink to answer the clinical questionnaire.
Initiating a Prior Authorization Request
3-34 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
.
The clinical questionnaire displayed in Step 9 must be completed before the prior
authorization can be completed. The responses are based on the clinical policies of the
health plan. All enabled questions require an answer.
Depending upon the responses given to previous questions, the questionnaire will enable
or disable (grey out) the appropriate questions.
If any additional clarification is needed, Help Icons are available as a reference. These
icons are Questions Marks found throughout the questionnaire. The User can hover over
the icon for reference information.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-35
If the user does not have all of the clinical information that they need to complete the clinical
questionnaire, they can click the Print hyperlink.
Clicking the Print hyperlink brings up a PDF of the fax form with all of the clinical questions.
Questions that were already answered by the user will show the answers already given. Questions
that have not been answered yet will all be enabled.
The user can then click the Save button to save the questionnaire and come back to it within five
days to complete it. If they do not come back to complete the prior authorization within five
days, the EOC will be automatically withdrawn and the user will have to start a new prior
authorization request. When the user is ready to complete the questionnaire, they will be brought
to Step 9 in the process and will click the Edit Answers link.
2. Once the clinical questionnaire is completed, click
If an answer is missed, the following prompt displays.
3. To continue, click and proceed to Step 10.
or
Click Cancel and return to the clinical questionnaire to complete the missed questions.
4. Complete any unanswered questions and click
Initiating a Prior Authorization Request
3-36 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Step10: Attach any supporting documents displays in the work area.
Attaching Supporting Documentation
Attaching Supporting Documentation is an easy process.
The files that are uploaded into ExpressPAth must be in one of the following formats.
PDF -- Used for both images and text
BMP -- Used primarily for images
GIF -- Used primarily for images
JPG -- Used primarily for images with photographic images requiring high-color
resolution
TIFF -- Used for images that span multiple pages
DOC - Microsoft Word 1997-2003— Used primarily for text
DOCX - Microsoft Word 2007—Used primarily for text
IMPORTANT: Individual file size cannot
exceed 4 MB each.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-37
To attach a document:
1. To locate the document, in the Select file field, click .
2. Locate the file on your computer then select the document by clicking on it.
3. Click the Open button.
The file displays in the Select file field.
4. In the Description field, enter an appropriate description for the file.
5. In the Document Type field, click the dropdown arrow and select the correct
description for the file document type.
Initiating a Prior Authorization Request
3-38 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
6. Click .
A summary of the attachments displays.
7. In the Comments and Additional Supporting Information freeform text box, enter
your comments or any additional information.
If you are unable to upload or scan information, Click the ―here‖ link to obtain a Barcoded fax cover sheet.
This cover sheet is barcoded for the health plan, when faxed; the information will be attached to the EOC.
8. When all files are attached, click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-39
Step 11: Review Submitted
A notification message indicates your answers will be submitted and you will be unable
to make changes.
9. To proceed and submit, click Yes.
Depending on the health plan and if all clinical criteria have been answered according to
the health plan’s policy, you may see an automatic approval, as shown below.
Complete PA Form redisplays with an Approved link to the PA request.
The health plan’s policy may require that the authorization be submitted to the health
plan for further clinical review.
Initiating a Prior Authorization Request
3-40 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
After the submission, a link is included to check the status of a submitted PA request.
The User will have three additional options that appear on the bottom of the screen after
the submission of a request:
1. Home- to return to the ExpressPAth landing page click
2. Additional PA- to request another PA for this patient, using the same
Demographics
click
3. Search PA’s- to check the status of previously submitted PA click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-41
Completing an existing Prior Authorization Request
A prior authorization (PA) that was not completed immediately after initiation may be completed
within ten calendar days by clicking on the Complete existing Prior Authorization requests link
on the Prior Authorization Portal.
The Complete Prior Authorization page displays in the work area.
Completing an existing Prior Authorization Request
3-42 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
This accesses the Open (or incomplete) prior authorization requests. If there are prior
authorization requests that need to be completed within ten days of the date initiated, a
message displays indicating the number of PA’s to be completed.
Note: An Open PA that has been initiated but not completed within ten days will be
removed from ExpressPAth.
To complete the next prior authorization request in your queue:
1. Click the Get Next PA in Queue link.
The prior authorization opens at the point where it requires attention.
2. Continue to complete the prior authorization.
To filter by patient to locate a prior authorization request:
1. Click the Filter by Patient link.
Step 1: Search by Patient Details displays in the work area.
2. To Search for the patient, at least one of the following fields is required:
First Name, Last Name, Date of Birth, Member/Insurance No., Group Number.
If you are an agent, you also must choose the appropriate prescriber/provider from the
Physician/Nurse dropdown.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-43
To search for a Prior Authorization started between a date ranges, enter the dates in the
Prior Authorization Start Date between fields.
3. Click
Search Results display in the work area.
4. To continue, click either the Complete PA link or the hyperlink of the patient’s name.
5. ExpressPAth will automatically take you to the first screen where you need to enter
information in order to complete the prior authorization request.
Checking the Status of a Previously Submitted PA Request
3-44 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Checking the Status of a Previously Submitted PA Request
To check the status of a previously submitted (complete) prior authorization request, on the Home
page:
1. Click on the Search for a previously submitted Prior Authorization request link
or
Click .
To search for a previously submitted prior authorization request:
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-45
1. Populate at least one of the fields indicated by a red identifier at the field end. If you are
an agent of a prescriber or providing facility, you must select the prescriber or provider
of the PA from the Physician dropdown menu.
Populating more fields with specific information filters the search results. For example,
if you know the patient’s member ID or Prior Auth (EOC) ID, the results will be specific
to your search
2. To search for a Prior Authorization started between a date range, enter the dates in the
Prior Authorization Start Date between fields.
3. To begin the search, click
Step 2: Search Results – Click on patient name (OR) Status to view details displays beneath
the original search.
1. To view details of the desired prior authorization, click the Patient Name hyperlink or the
Status hyperlink.
Note that related prior authorizations appear together in the search results and are
outlined with a
Checking the Status of a Previously Submitted PA Request
3-46 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
If the status is Approved, you will see the screen below. The top section under Step 3: Prior
Authorization Status reflects the information requested. The bottom section, Authorized Drug
Details, reflects the approved prior authorization parameters.
Search results could also show a status of Denied or In Progress. Depending on the
status reflected, several other options are available to the user. These options include:
Withdraw, Copy & Update PA, Update NPI, Appeal or Renew.
Initiating an Appeal
3-48 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Withdrawing a Prior Authorization
A user may withdraw a prior authorization request after a prior authorization has been submitted,
but while the decision status is still In Progress. This may be necessary if an error was made and
noted after submission of the request.
To withdraw a prior authorization:
1. Go to the Search for a previously submitted Prior Authorization request link.
2. Search by EOC, patient name or other search criteria, as previously mentioned.
3. Locate the appropriate EOC with status of In Progress
4. Click the Withdraw hyperlink.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-49
A popup box displays with the EOC ID of the prior authorization and the name of the patient.
4. If you want the prior authorization to be removed and no longer accessible, in the popup
box, click Yes.
The prior authorization no longer displays in your Search for previously submitted
Prior Authorization requests list.
Initiating an Appeal
3-50 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Copying and Updating a Prior Authorization
ExpressPAth has a Copy & Update PA feature for prior authorization requests that saves time
when additional PA requests are needed for the same patient.
To start the copy and update process:
1. Go to the Search for a previously submitted Prior Authorization request link.
2. Search by EOC, patient name or other search criteria, as previously mentioned.
3. Locate the appropriate EOC with status of Approved
Search Results display beneath the search criteria.
The Copy & Update PA link displays in the upper right corner of the search results
Copy and Update is designed as a shortcut for creating a PA request for the same
patient. It allows you to change any of the information except the patient’s member
profile.
1. Click Copy & Update PA hyperlink of the desired patient.
A popup displays to remind you that a copy of this prior authorization will be created.
Click Yes.
You will be taken to Step 3: Select Drug/Service. From here, you can begin to enter details about the new request, such as the drug/service, additional information, prescriber and clinical questions. Please refer to the Initiate a Prior Authorization Section, beginning on page 9.Initiating an Appeal (Select Clients ONLY)
If a prior authorization is in Denied status, an appeal request may be submitted to have the denial
re-evaluated. ExpressPAth supports up to five levels of Appeals.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-51
NOTE: Appeals are not supported by ExpressPAth for every health plan. If you do not see an
Appeal link for your member on a Denied EOC request, please contact your health plan directly
to process an appeal.
To begin the appeal process:
1. Go to the Search for a previously submitted Prior Authorization request link.
2. Search by EOC, patient name or other search criteria, as previously mentioned.
3. Locate the appropriate EOC with status of Denied
4. To appeal this status, click
To view more information about the EOC prior to initiating an appeal, you can click on either
the Patient Name hyperlink or the Denied Status link. This will take you to the EOC
details screen, where you can view the Outcome Explanations and a copy of the
notification sent to the prescriber. If you still wish to make an appeal after viewing the
details, you can click the link to Appeal this Request.
Initiating an Appeal
3-52 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The Initiate an Appeal Request page displays in the work area, with the details of the
PA.
7. Review the details of the prior authorization.
8. Enter any comments or additional information related to this prior authorization request
and/or attach any additional supporting documentation (see Initiating a Prior
Authorization Request – Step 10: Attaching Supporting Documentation on page 36 of
this user guide).
9. Click
A message indicates you have successfully initiated an appeal request.
10. Click
Initiating a Prior Authorization Renewal
3-54 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Initiating a Prior Authorization Renewal
A prior authorization which will expire in 90 days or less may be renewed one of two ways: 1)
Click on the Renew a Prior Authorization Request link 2) Click Search for a previously submitted
Prior Authorization request and locate an approved EOC that has a Renew link.
To begin the PA renewal process by using the Renew a Prior Authorization request link:
1. On the Prior Authorization Portal for Physicians page, click the Renew a Prior
Authorization request hyperlink
or
Click .
Step 1: Search for Prior Authorizations eligible for renewal displays, with PA’s
expiring in the next 90 days displays. This is the default.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-55
1. You can conduct a search, as discussed in the Search for a previously submitted Prior
Authorization request section. Once the EOC displays in the Search Results below,
click the link.
Step 2: Initiate Renewal displays in the work area.
Initiating a Prior Authorization Renewal
3-56 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
3. Review the Renewal Request fields for this prior authorization. Several fields are
editable, and can be updated if necessary.
4. Enter comments or additional information, if needed.
5. Click
A message displays to confirm that you have successfully initiated a renewal request.
6. Click
A renewal may have no clinical questions, a different set of clinical questions than the initial
request, or the same questions as the original request. This is dependent upon the health plan’s
benefit set-up.
Complete the clinical questionnaire and attach any supporting documentation (if necessary).
Refer to Steps 9 and 10 of Initiating a Prior Authorization Request starting on page 33 for
instructions.
Updating Rendering Provider NPI
3-58 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Updating Rendering Provider NPI
If the rendering provider information on a submitted claim does not match the rendering provider
information on the prior authorization, the claim rejects.
If this happens, providers and agents associated to the approved authorization may receive an
email from the member’s health plan, requesting an NPI update. The link in the email brings the
authorized users to the authorization in ExpressPAth that requires the update. The authorized
users then have the ability to update the rendering provider NPI so that claims submitted using the
authorization will process appropriately.
Another way to update the rendering provider NPI is to locate the episode of coverage (EOC). If
the status of the EOC is ―Approved‖ and the health plan has requested that users associated to the
prior authorization in ExpressPAth update the NPI, an Update NPI link displays. After clicking
the Update NPI hyperlink, the prior authorization page displays the current rendering provider
information and contains links to change the rendering provider.
Updating Rendering Provider from an Email Link
If you have received an email requesting an update to the Rendering Provider information, you
are able to begin your update from the email. The email may contain the updated NPI that should
be associated to the rendering provider. If the NPI is not included in the email, you need to
update the NPI to the billing NPI the provider is using on the claim.
To start the Rendering Provider NPI Update from the email link:
1. Click the link embedded in the text of the NPI update email.
Note: If the EOC in question is being used by another ExpressPAth user, you will
receive a message that the record is locked. You will need to wait for the EOC
to be unlocked to make changes to it. You cannot continue at present.
or
If the EOC is available and the Rendering Provider NPI has already been
updated, ExpressPAth will return a message that this information has already
been updated. There is no need to continue.
2. If the EOC is not locked and the Rendering Provider NPI has not been updated, log into
the ExpressPAth Portal after clicking the hyperlink in the Update NPI email.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-59
ExpressPAth displays the previously submitted prior authorization request requiring an
NPI update.
Current Rendering Provider Information is shown, including NPI information.
Note: If the updated NPI was provided by the member’s health plan, the system returns
the Rendering Provider information, including current and updated NPI
information.
Editing the Provider
To change the NPI by editing the Provider:
1. If the desired Provider displays but the NPI information is incorrect, in the Change
Rendering Provider area click the Edit Provider Link.
Updating Rendering Provider NPI
3-60 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The Edit Rendering Provider box displays.
2. In the NPI field, update the NPI number. Update any other relevant information, if
necessary.
3. Click
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-61
4. The Rendering Provider page redisplays with current and updated NPI information.
5. To update the information, click
ExpressPAth redisplays the page with the updated NPI information.
To cancel the update, click
Picking from Favorites
To change the Rendering Provider by selecting from your Favorite Rendering Providers list:
1. Click the Pick From Favorites link.
Updating Rendering Provider NPI
3-62 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The My Favorite Rendering Provider(s) list displays as a pop-up box.
2. Locate the provider on your My Favorite Provider(s) list.
3. Click the Provider Name link.
The selected favorite rendering provider displays on the Change Rendering Provider
area of the page.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-63
4. To update the prior authorization with this rendering provider, click
or
To cancel this provider selection, click
If the desired rendering provider is not on your My Favorite Rendering Provider(s) List,
you are able to search for the provider.
Searching for a Rendering Provider
To search for a rendering provider:
1. Click the Search Provider link.
The Search Rendering Provider form displays. You are able to search for an existing
rendering provider using this form.
2. In the NPI field, type the NPI number of the rendering provider.
or
In the First Name and Last Name fields, type the name of the rendering provider.
or
In the Facility Name field, type the name of the rendering facility.
3. Click
Updating Rendering Provider NPI
3-64 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
The results of the Rendering Provider search display.
4. To select a rendering provider from the search results for the desired provider, click the
Provider Name link.
The selected rendering provider is displayed in the Change Rendering Provider area of
the page.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-65
5. To update the prior authorization with this rendering provider’s NPI, click
or
To cancel this provider selection, click
Adding a New Provider
To change the Rendering Provider by adding a provider:1. Click the Add new Provider link.
The Add new Rendering Providerform displays as a pop-up box.
2. You must enter the Provider details in the following required fields, marked with a
red asterisk (*):
Updating Rendering Provider NPI
3-66 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
NPI
Specialty
Taxonomy Code
First Name
Last Name
Address Line 1
City
State
Zip
Work Phone
Email address
3. When the required fields are populated, click
The added provider displays in the Change Rendering Provider area of the page.
4. To update the prior authorization with this rendering provider, click
or
To cancel this provider selection, click
Updating Rendering Provider from a Prior Authorization
To start the Rendering Provider NPI update from the Prior Authorization:
1. Go to the Search for a previously submitted Prior Authorization request link.
2. Search by EOC, patient name or other search criteria, as previously mentioned.
3. Locate the appropriate EOC with status of Approved.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-67
Click the Update NPI link.
The Update previously submitted requests area displays with the current NPI
information for this prior authorization.
Updating Rendering Provider NPI
3-68 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Blue Cross Blue Shield of Massachusetts (BCBSMA) Providers ONLY:
Initiating a Prior Authorization Request for Home Infusion Therapy (HIT)
If a provider is registered as a Specialty Pharmacy, Home Infusion Therapy Agency, or a Dialysis
Center, or an agent thereof, additional HIT drug/service options are available when initiating a
prior authorization.
The Home Infusion Therapy (HIT) categories are most commonly used to initiate a HIT prior
authorization request.
The request process for a HIT prior authorization is the same as a non-HIT request until the 3rd
step.
To initiate a prior authorization request for a home infusion therapy product:
1. On the Prior Authorization tab page, also known as the Prior Authorization Portal for
Physicians, click on the Initiate a new Prior Authorization request link.
or
To the right of this link, click
The Step 1: Search for a Patient form displays in the work area. On the left side of
the page, your initiation progress is tracked.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-69
2. To view available health plan choices, click the Insurance List dropdown arrow.
3. To select the patient’s health plan from those displayed on the Insurance List
dropdown, click on Blue Cross Blue Shield of Massachusetts (BCBSMA). This is a
required field.
Note: The patient must be a Blue Cross Blue Shield of Massachusetts (BCBSMA)
member and the ExpressPAth user must be registered as a Home Infusion
Therapy Provider, Specialty Pharmacy, Dialysis Center, or agent thereof to enter
a request for a prior authorization using this method.
4. Locate the patient by searching by Member Id
or
Locate by searching with a combination of Last Name, First Name and Date of Birth.
5. Enter the patient search criteria and click
Step 2: Patient Search Results displays.
Note: Based on the search criteria entered, one or more patient eligibility records will
display.
6. If multiple records display, locate the correct patient.
Updating Rendering Provider NPI
3-70 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
1. In the Medical Coverage Details section, confirm that the patient has active Medical
Eligibility.
If the patient does not have active Medical Eligibility, do not proceed.
HIT prior authorizations can only be requested for patients with BCBSMA medical
coverage and active eligibility.
2. If the patient has a Medical Eligibility Status of Eligible and is the correct patient, click
on the Patient Name hyperlink.
Step 3: Search and select drugs or ancillary services displays.
If a provider is registered as a user who can perform HIT prior authorizations for
BCBSMA, additional drug/service options are available when initiating a prior
authorization.
To search for a Home Infusion Therapy category,
1. In the Search for Home Infusion Therapy section, click the Select Category dropdown.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-71
A list of Home Infusion Therapy options available for this client displays.
The Home Infusion Therapy categories are most commonly used to initiate a HIT prior
authorization request.
2. To select a Home Infusion Therapy category for the patient, click on the category.
3. When a category has been selected, click
Updating Rendering Provider NPI
3-72 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
A list of drugs included in the selected HIT category displays.
You can also search for a specific drug by NDC, Drug Name, or HCPCS/CPT Code
instead of using the HIT category list.
4. To select the drug you are requesting for the patient, click the drug name.
Drug search results display for the selected drug.
5. Locate the NDC for which you are seeking prior authorization. You may need to scroll
to find it.
6. To add the drug to the request, click on its Drug Name hyperlink.
In the Search and Select drugs or ancillary services section, the selected drug displays
on the Selected Drugs/Services List.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-73
When initiating a HIT prior authorization request, you have the option to request up to
twelve drugs and/or services on a single request.
The first drug or service selected displays at the top of the form.
To add another drug or service to the request, click
1. Repeat the process for HIT selection to add drugs/services.
The next selection can be from the same category or from a different category.
Updating Rendering Provider NPI
3-74 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
2. In the Search for Home Infusion Therapy section, click the Select Category dropdown
arrow.
1. Select the designated category.
2. Click .
3. Search Results display the drugs/services in the selected category.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-75
6. Locate the NDC for which you are seeking prior authorization. You may need to scroll
to find it.
7. To add the drug to the request, click on its Drug Name hyperlink.
The second drug or service displays in the Selected Drugs/Services List.
Note: When multiple drugs/services are requested, you always have the option to
remove the item from the request.
To remove a drug or service from the request, deselect the checkbox of the item
to be removed.
8. When you have completed additions to the request, click
Updating Rendering Provider NPI
3-76 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
If the patient’s benefit design is set for it, Step 4 – Formulary/Preferred Alternatives
displays.
If formulary alternatives are available, you have the option to replace the non-preferred
drug that was selected with a preferred alternative drug.
This step is bypassed when no preferred alternatives are available, depending on the
patient’s benefit design.
If Step 4 does not display or after Formulary Alternative choices have been made, if
appropriate, Step 5- Additional Information displays.
If the request includes multiple drugs/services, you must complete the Additional
Information section for each drug/service.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-77
To complete Step 5: Additional Information:
1. In the New/On-going field, if this is a new prior authorization request, select New.
or
If this is not a new prior authorization request, select On-going.
2. If you believe that the standard review timeframe may seriously jeopardize the life or
health of the patient or the patient’s ability to regain maximum function, choose Yes in
the Is this an Urgent Request field.
The default for this field is No.
3. To add comments to this request, type your comments in the Comments free-form text
field.
4. To select the method of administration of the drug, in the Selected Drugs/Services
section, click the Route dropdown.
Updating Rendering Provider NPI
3-78 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
5. Set the Date fields appropriately. The Start Date defaults to the current date. The End
Date is calculated based on the Duration field.
The Duration field displays a default value based on the product or service selected, but
will automatically re-calculate based on the data entered into the No of Refills and Days
Supply fields.
6. In the appropriate fields, indicate the Quantity and Days Supply instructions for each
drug/service on the HIT prior authorization request.
The Quantity field refers to the total number of units prescribed for the selected
drug/dosage per the indicated Days Supply.
For example: For a drug that is prescribed for 2 tablets per day with a Days Supply of 7
days, you would enter 14 in the Quantity field.
7. Days Supply refers to the total number of days that the supply of medication in the
Quantity field should last the patient for a single fill.
Once the field has re-calculated, you can manually enter the length in days you want the
prior authorization to be valid.
8. In the No. of Refills field, enter the number of refills you are requesting. Do not include
the initial fill.
9. In the Directions field, type specific drug administration directions.
Note: To remove a drug/service from the request, click then click
The deselected drug or service is removed.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-79
Step 6- Select a Dispensing Location displays in the work area.
The Dispensing Location is the site where the requested drugs/services are
administered.
When requesting a HIT drug/service, the only dispensing location option is Home
Infusion.
Note: Non-HIT providers have additional dispensing location options available to
them.
To select Home Infusion as the Dispensing Location, click
Updating Rendering Provider NPI
3-80 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Step 7- Verify Prescribing Physician or Nurse Practitioner displays in the work area.
A Prescriber is licensed to write a prescription for a drug or service (such as a
Physician, Nurse Practitioner, Physician’s Assistant or a Pharmacist).
In this section, you add the prescriber’s information to the request.
To locate the prescriber’s information, click
The Search Prescriber box displays.
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-81
To search for prescribers:
1. In the NPI field you may type the prescriber’s NPI number
or
You may search by Prescriber First Name and Last Name,
or
You may search by Facility Name.
2. Click Search.
The results of your search display at the bottom of the Search Prescriber box.
You may need to scroll to locate the appropriate prescriber.
Note: If you cannot locate the prescriber’s information, you have the ability to
manually add the prescriber’s information.
3. To add the prescriber to the request, click the Prescriber Name link.
Updating Rendering Provider NPI
3-82 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
Step 7: Verify Prescribing Physician or Nurse Practitioner displays with the
prescriber’s details.
4. Click
Step 8: Select the Rendering Provider displays in the work area.
A Rendering Provider is licensed to administer a drug or service (e.g. Physician’s
Office, Home Infusion Therapy Agency, Specialty Pharmacy, Outpatient Facility or a
Dialysis Center).
You may need to select a different provider or location information from the default
display.
Based on your selection, you may need to make changes to the Provider Details
section.
The final 3 steps to complete this HIT request are:
Answer the Clinical Questionnaire
Attach Supporting Documentation
Submit the Prior Authorization request
This process is referred to as ―Completing a Prior Authorization Request.‖
Prior Authorizations
09/26/2011 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
3-83
Duplicate Prior Authorizations – Medical Benefit
A medical prior authorization request is considered a duplicate when a PA already exists for the
same patient, drug classification and overlapping date range (start and end date). ExpressPAth
will not allow you to create a new medical prior authorization request at Step 8 if:
The request is for a prior authorization with the same patient, drug classification and
overlapping date range with a DIFFERENT provider. You will receive this message:
The request is a duplicate of more than one EOC in ExpressPAth (for the same or different
providers). You will receive this message:
If you are trying to create a prior authorization and an EOC for that patient, drug classification
and provider already exists in ExpressPAth, the system will check to see if the original PA end
date is within 90 days of the new PA start date. If it is, the system will check to see if you are
actually trying to create a Renewal. The following screen will display:
Updating Rendering Provider NPI
3-84 ExpressPAth User Guide
Client Application Training Department
© Express Scripts, Inc.
09/26/2011
If you are trying to create a Renewal, click Yes. The system will take you to the clinical
questionnaire for the renewal and you can proceed from there.
If you are not attempting to create a Renewal, click No. ExpressPAth will perform an update to
your original PA with the new information.