Surescripts Prior Authorization
Prior authorization software
Health care software
Health care operations software
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What is Surescripts Prior Authorization
Surescripts Prior Authorization is an electronic prior authorization (ePA) solution that supports initiating, routing, and receiving payer determinations for prescription medications within clinical and pharmacy workflows. It is used by prescribers, health systems, EHR vendors, and pharmacies to reduce manual phone/fax processes and to exchange PA questions and responses electronically. The product is typically delivered via integration to EHR and pharmacy systems using Surescripts network connectivity and transaction standards. It focuses on medication prior authorization rather than broader medical (procedure) authorization workflows.
Broad network-based connectivity
The product operates through the Surescripts network, which is widely used for e-prescribing and related medication transactions in the U.S. This network approach can simplify connectivity for organizations already connected to Surescripts for eRx and medication history. It supports electronic exchange between prescribers and payers without requiring point-to-point integrations in many cases.
Embedded in prescribing workflows
Surescripts Prior Authorization is commonly implemented as an EHR-integrated workflow so clinicians can initiate and respond to PA requests where they prescribe. This reduces context switching compared with standalone portals and helps align PA steps with medication ordering. The approach is well-suited to high-volume ambulatory prescribing environments.
Standards-based ePA transactions
The solution supports electronic PA transactions that align with industry ePA standards used by payers and EHRs. This enables structured question/answer exchanges and electronic determinations rather than unstructured fax attachments. Standards alignment can improve interoperability across multiple payer formularies and PBM processes.
Integration-dependent user experience
Functionality and usability vary based on how an EHR or pharmacy system implements the integration. Some organizations may experience inconsistent workflows, limited UI controls, or partial feature exposure depending on their vendor’s build. Implementation timelines and testing effort can be significant for custom or legacy environments.
Medication PA scope focus
The product is primarily oriented to pharmacy benefit and medication prior authorizations. Organizations needing a single tool for both pharmacy and medical prior authorization (procedures, imaging, DME) may require additional systems or workflows. This can create operational fragmentation for revenue cycle and utilization management teams.
Variable payer participation and rules
Electronic PA success depends on payer/PBM support for ePA transactions and the completeness of their rule sets and questionnaires. Some requests may still fall back to manual processes when payers require attachments, have non-standard criteria, or do not support real-time electronic determinations. This can limit end-to-end automation rates across all payers.
Seller details
Surescripts, LLC
Arlington, VA, USA
2001
Private
https://surescripts.com/
https://x.com/surescripts
https://www.linkedin.com/company/surescripts/
