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MedHOK’s Pharmacy Prior Authorization Solution

Pharmacy Prior Authorization

Solution Overview

MedHOK’s Pharmacy Prior Authorization solution comes out of the box fully CMS-compliant for Medicare and is easily configurable for other lines of business, including Medicaid, the Exchanges and Commercial business. Our cutting edge platform allows for real-time monitoring of activity and promotes a proactive approach to workload management. MedHOK is fully integrated with First Data Bank and Medi-Span for up to the minute FDA and manufacturer guidelines. MedHOK is also capable of integrating with all major PBM’s. Our solution includes:

  • A seamless intake process with re-route and forwarding capabilities
  • Automatic member eligibility verification
  • Ability to link appeal to original case information
  • Configurable decision trees aid in decision making process
  • Auto effectuation of approvals in client claim system
  • Automatic correspondence generation based on case status and/or action taken
  • Real-time dashboard reports and alerts for proactive monitoring
  • Pre-built reporting tools as well as business intelligence tools for ad hoc reporting needs

Customers use the solution to:

  • Simplify the appeal process for associates, members and providers
  • Create custom, business-specific workflow rules and routing
  • Remain compliant with federal and state regulations
  • Integrate with IVR and fulfillment vendors to ensure appropriate outreach and communication
  • Manage utilization management edits with minimal impact for protocol and/or formulary changes

Have You Considered …

You may also want to manage appeals-related functionalities on one platform to ensure compliance, improve efficiency and productivity, and deliver better quality care. Consider adding these other MedHOK pharmacy solutions:

Medication Therapy Management
Pharmacy Appeals
Medical Appeals


Pre-configured to be fully compliant day one with Medicare, Medicaid and Commercial/Exchange LOBs


Integrates with PBMs to auto effectuate claims for approvals, removing administrative burden


Out-of-the-box best practice workflows to ensure compliance and increase efficiency

See How Industry-Leading Payers Use MedHOK’s Pharmacy Prior Authorization Solution

Please complete the form and let us know which capabilities you would like to see. One of our demo specialists will contact you to schedule your custom demo.

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