Prior Authorization

Applying Prior Authorization Services for each Specialty Management Program enables Onicol to process the majority of requested services through Onicol's automated Medical and Pharmacy Management System. All of Onicol's proprietary Protocols and Pathways have sophisticated algorithms that serve as the nerve center for prior authorization. As a result, the vast majority of requests can be processed in real time, while other requests may be pended for medical necessity or eligibility. In this way, Providers can immediately perform routinely approved services and focus their energies on better outcomes and more complicated service requests that require proof of medical necessity. As changes are made to the Protocols and Pathways through the Utilization Management (UM) process, Pharmacy and Therapeutics (P&T) Committee and MAB, the Medical and Pharmacy Management Systems will be updated simultaneously to reflect those changes. Thus Onicol will provide a continuity of care from the UM Committee to daily authorization procedures. The result:

  • Onicol can authorize all services — Most services are processed in real time online
  • Only exceptions requiring verification of eligibility or proof of Medical Necessity will be pended for review
  • Onicol will not authorize a service if there is a missing outcome from a previous service within that specialty