Partnering to Rebuild and Deliver Superior Pharmacy Benefits
Teachers Health Trust (THT) is proud to partner with CerpassRx, a leading prescription benefit manager (PBM), to deliver exceptional pharmacy benefit services to our members. CerpassRx specializes in simplifying complex processes, driving significant cost savings, and enhancing healthcare outcomes through advanced prescription benefit solutions.
Together, we offer members access to innovative programs like the Prescription Optimization Program (POP), designed to maximize savings by maximizing patient assistance programs and copay cards to reduce out-of-pocket expenses. Through this collaboration, THT and CerpassRx are committed to empowering members with solutions that reduce costs and improve their overall healthcare experience.
We believe that healthcare providers are the cornerstone of effective patient care. That’s why we provide tools, resources, and support designed to simplify your workflow, reduce administrative burdens, and enhance the patient experience.
Exclusive Pharmacies
Fill your prescriptions at any of these pharmacies.
Prescriptions filled at pharmacies other than THT’s Exclusive Network Retail Pharmacies will incur a $10 per prescription choice fee in addition to applicable copays. The pharmacy choice fee does not accumulate toward your out-of-pocket maximum.
Simplify Your Prior Authorization Process with CerpassRx
You can submit a Prior Authorization (PA) request via electronic submission (ePA), fax, or mail. CerpassRx has partnered with Surescripts to provide a no-cost, easy-to-use ePA solution that eliminates the need for traditional processes like mail and fax. Learn more about ePA here.
Alternatively, you can submit a PA via fax by sending completed PA forms and supporting clinical documentation to (469) 592-6460. Be sure to include only one member and one prescription per request, attach all relevant clinical documentation, and double-check for missing or incorrect information before faxing.
For mail submissions, send completed PA forms and supporting documentation to CerpassRx at:
5904 Stone Creek Drive, Suite 120
The Colony, Texas 75056.
Streamline Your Workflows with ePA (Electronic Prior Authorization)
CerpassRx has partnered with Surescripts to bring the power of ePA directly to prescribers and their staff. Our ePA platform simplifies and accelerates the PA process, saving you valuable time while ensuring your patients receive their medications faster. Key benefits of using ePA include:
- Real-Time Updates: Immediate feedback on the status of PA requests.
- Integrated Workflow: Seamlessly submit PAs through your EHR system.
- Faster Turnaround Times: Approvals and decisions are often provided instantly or within hours.
Getting Started with ePA in 3 Simple Steps
- Register
Register on the Surescripts Prior Auth Portal, Surescripts Prior Auth Portal. Create your prescriber account using your NPI, or work on behalf of a prescriber with a delegate account.
- Sign In
Log in to the portal to access your worklist, view task history, and manage your account settings seamlessly.
- Start Your Prior Authorization
Prescribers interested in Surescripts services can visit the Surescripts Provider Portal for information and free sign-up. For personalized support, contact Surescripts Customer Support at (866) 797-3239 and follow the prompts. For all other questions call CerpassRx at (844) 622-1797.
Helpful ePA Resources:
- Prior Authorization Portal User Guide: Step-by-step instructions to maximize the benefits of ePA.
Your Guide to Understanding the Prior Authorization Process
The PA process can sometimes be complex, but we’re here to help make it easier for prescribers, patients, and caregivers. Below are answers to frequently asked questions (FAQs) about submitting, tracking, and managing PAs. Whether you’re using ePA, fax, or mail, we’ve got you covered with everything you need to know to streamline the PA process and ensure timely access to medications.
How do I submit a Prior Authorization?
You can submit a Prior Authorization (PA) request via electronic submission (ePA), fax, or mail. Each method is outlined below:
- Electronic Submission (ePA): CerpassRx has partnered with Surescripts to bring the power of ePA directly to prescribers and their staff—at no cost to you! This collaboration provides access to all prescribers to an easy-to-use, efficient solution that eliminates the hassle of traditional PA processes, such as mail and fax.
Getting Started with ePA in 3 Simple Steps
- Register
Register on the Surescripts Prior Auth Portal, Surescripts Prior Auth Portal. Create your prescriber account using your NPI, or work on behalf of a prescriber with a delegate account.
- Sign In
Log in to the portal to access your worklist, view task history, and manage your account settings seamlessly.
- Start Your Prior Authorization
Prescribers interested in Surescripts services can visit the Surescripts Provider Portal for information and free sign-up. For personalized support, contact Surescripts Customer Support at (866) 797-3239 and follow the prompts. For all other questions call CerpassRx at (844) 622-1797.
- Fax: Send completed PA forms with supporting clinical documentation to (469) 592-6460. Here are some helpful tips for fax submissions:
- Include only one member and one prescription per request.
- Attach all relevant supporting clinical documentation.
- Double-check for missing information and accuracy before faxing.
- Mail: Send completed PA forms with documentation to the following address:
CerpassRx
5904 Stone Creek Drive, Suite 120
The Colony, Texas 75056
How can I use PA Pulse?
Members can utilize CerpassRx PA Pulse, our real-time tracker, to monitor the status of submitted PAs. Log in to view progress updates, required next steps, and final decisions.
What is ePA?
ePA is a digital process that simplifies and accelerates the prior authorization (PA) submission, review, and approval of PA requests for medications. Unlike traditional methods that rely on manual paperwork, faxes, or mail, ePA integrates directly into healthcare providers’ workflows, such as electronic health records (EHRs) or online portals, to make the process more efficient.
Key Features of ePA:
- Real-Time Communication:
- Provides immediate feedback on missing or incorrect information.
- Notifies prescribers of approval or denial decisions much faster than manual methods.
- Integration with EHRs:
- ePA is often built into electronic health record systems, allowing prescribers to submit and track requests without leaving their clinical platform.
- Faster Decision Times:
- Reduces turnaround time by eliminating delays caused by faxing, mailing, or manual processing.
- Many requests can be processed instantly or within hours.
- Improved Accuracy:
- Digital forms reduce errors by guiding prescribers to complete all required fields before submission.
- Enhanced Transparency:
- Prescribers can track the status of PAs in real-time, reducing uncertainty and follow-up calls.
What are the disadvantages to not using ePA?
Not using ePA can lead to several inefficiencies and delays, as the process relies on manual, fax-based communication and review. This traditional method typically results in turnaround times of hours to days, slowing access to necessary medications. The manual workflow involves multiple steps: the prescriber must first request the PA Question Set from CerpassRx, who then sends it via fax. Once received, the prescriber completes the PA Question Set and faxes the responses back to CerpassRx. CerpassRx reviews the answers, either communicating a decision or returning the request to the prescriber for corrections or additional information. Each step introduces the potential for delays or miscommunications.
How can I check the status of a PA within ePA?
To check the status of a PA, prescribers can utilize the Surescripts workflow’s Task History feature. This tool allows prescribers to track the status and details of every action completed during the PA process. By selecting Task History, prescribers can view whether Question Sets have been completed, responses have been acknowledged, or if a PA is awaiting a response from CerpassRx. For more detailed guidance on the electronic Prior Authorization (ePA) process, prescribers can refer to the Prior Authorization Portal User Guide.
Additionally, patients can track the status of PA requests using CerpassRx PA Pulse, a real-time tracking platform. PA Pulse offers a variety of features designed to make the PA process more transparent and efficient:
- Real-Time Updates: Instantly view the status of PA requests, including submission acknowledgment, review progress, and final decisions.
- Comprehensive Dashboard: Access a centralized platform that provides a clear overview of all active and completed prior authorizations.
- Actionable Notifications: Patients can customize their notifications to receive real-time updates via letter, email, phone call, or text.
- User-Friendly Interface: Navigate easily to check statuses and resolve issues quickly.
- Secure and Compliant: Built to meet stringent data security and privacy standards.
Patients can simply click here to access PA Pulse.
What happens if I do not agree with the decision?
If your PA request is denied, members and prescribers have the right to appeal. Appeals must be submitted in writing within 180 days of the denial notification.
- How to Appeal:
- Include all relevant clinical information, medical reports, or additional documentation to support your case.
- Ensure you include the patient’s name, address, identification number, and the reason for the appeal.
- Send your appeal via mail or fax:
- Address: CerpassRx, 5904 Stone Creek Drive, Suite 120, The Colony, Texas 75056
- Fax: (469) 592-6460
- Appeal Types:
- Standard Appeal (15 days): A decision will be provided within 15 days.
- Fast Appeal (48 hours): If the patient’s health is at risk, you can request an expedited review. Documentation indicating urgency will automatically grant a fast appeal.
What should I include in my appeal?
To ensure your appeal is reviewed efficiently, include the following:
- Patient’s full name, address, and identification number.
- A detailed explanation of the reason for the appeal.
Supporting documentation such as medical reports, prescriber letters, or clinical information.
Who may file a request for an external review?
Prescribers may file an external review request if your appeal is denied. Details for requesting an independent review will be provided upon denial of your appeal.
What if the plan denies your appeal again?
For most claims, you have the right to request an independent external review within 120 days of receiving an adverse appeal decision. Contact CerpassRx for assistance at (844) 622-1797.
Who do I contact if I have any additional questions?
Prescribers using ePA within their EHR should begin by contacting their EHR vendor, as many questions can be resolved through a simple support ticket. Alternatively, prescribers can reach the Surescripts support team directly at (866) 797-3239 for additional assistance. If you have any questions about submitting Prior Authorizations, ePA, or filing appeals, please contact CerpassRx Member Services at (844) 622-1797.
Key Resources to Get You Started:
- Surescripts Prior Auth Portal
Access everything you need to streamline PAs in one place. (Surescripts Prior Auth Portal) - Surescripts ePA Video: Electronic Prior Authorization Overview
A quick, engaging overview of how ePA transforms your workflow. (Electronic Prior Authorization Overview) - Surescripts Multi-Factor Authentication (MFA) Guide
Stay secure with step-by-step instructions and FAQs. (Surescripts MFA FAQs) - Surescripts User Guide: Prior Authorization Portal
Master the portal with an in-depth guide to every feature. (Prior Authorization Portal User Guide)
Navigating Our Comprehensive Formulary for Optimal Patient Care
Our advanced clinical programs and tools are designed to support prescribers in delivering cost-effective, high-quality care. Access our comprehensive formulary to make informed decisions that align with your patients’ benefits.
CerpassRx’s formulary drug list is a comprehensive guide to the medications covered under our prescription benefit plan. It includes both generic and brand-name drugs, as well as information on formulary tiers, preferred medications, and any restrictions or requirements for certain drugs. Prescribers can use this list to identify covered medications and ensure that prescriptions align with plan guidelines. It helps streamline the PA process by providing up-to-date information on which drugs are covered and if prior authorization is required. The formulary drug list is regularly updated, and prescribers can access it through the CerpassRx website or the Surescripts Prior Auth Portal.
Access our comprehensive formulary to make informed decisions that align with your patients’ benefits.
WellDyne Specialty Pharmacy Services
Through our partnership with WellDyne, prescribers and patients benefit from a trusted specialty pharmacy provider offering personalized care, medication management, and adherence support for complex conditions.
The WellDyne Specialty Drug List provides prescribers with information on specialty medications available through WellDyne Pharmacy Services. This list helps guide prescribers in choosing cost-effective medications for their patients while ensuring access to necessary treatments. Prescribers can review the list to determine which specialty medications are available through WellDyne and ensure that all required documentation is included with PA submissions.
Essential Guides & Resurces for Streamlined Patient Care
Discover a collection of valuable tools and resources to simplify the PA process and improve workflow efficiency. These materials provide prescribers with everything they need to navigate electronic submissions, track PA requests in real-time, and access secure, user-friendly portals to enhance their practice. Explore each resource to streamline your PA experience and offer patients faster, more effective care.
ePA Flyer
The ePA flyer provides prescribers with an overview of how to streamline the Prior Authorization (PA) process using CerpassRx’s partnership with Surescripts. This flyer highlights the benefits of using electronic submissions, how to get started with ePA, and how it simplifies workflows for quicker, more efficient PA processing. ePA Flyer
THT ePA Presentation
The THT ePA presentation is a valuable resource that outlines how THT has partnered with CerpassRx to enhance the PA process for their members. This presentation provides an in-depth look at how ePA streamlines the process and saves time, as well as instructions for prescribers on how to utilize ePA effectively. ePA Presentation
PA Pulse Flyer
The PA Pulse flyer introduces prescribers to a powerful tool for real-time tracking of PA requests. This flyer explains how PA Pulse provides instant updates on submission acknowledgment, review progress, and final decisions. It also details how prescribers can efficiently manage multiple PA requests through a user-friendly interface. PA Pulse Flyer
Surescripts Prior Auth Portal
Access everything you need to streamline PAs in one place. The Surescripts Prior Auth Portal centralizes your worklist, task history, and account management for a seamless experience. Surescripts Prior Auth Portal
Surescripts Multi-Factor Authentication (MFA) Guide
Stay secure with step-by-step instructions and FAQs on setting up and using Multi-Factor Authentication (MFA) to enhance the security of your ePA submissions. Surescripts MFA FAQs
Surescripts User Guide: Prior Authorization Portal
Master the Prior Authorization Portal with this in-depth guide to every feature, from submitting PAs to tracking progress and managing your account settings. Prior Authorization Portal User Guide
Surescripts ePA Video: Electronic Prior Authorization Overview
Watch this quick, engaging video to learn how ePA transforms your workflow by eliminating the hassle of traditional PA processes like fax and mail. Electronic Prior Authorization Overview
Contact Us
If you have questions about prior authorizations, formulary access, or specialty medications, please reach out to:
CerpassRx Member Services: (844) 622-1797
Fax for Prior Authorization Submissions: (469) 592-6460
CerpassRx Mailing Address: CerpassRx, 5904 Stone Creek Drive, Ste. 120, The Colony, Texas 75056
Thank you for partnering with THT to provide exceptional care to your patients. Explore our resources, streamline your workflow, and experience the CerpassRx difference today!