Starting a Continuation Evaluation
When a prior authorization is approaching its expiration date, you can initiate a continuation evaluation directly from the PA Expirations page. The wizard walks you through three steps: selecting the guideline, reviewing baseline data, and confirming the submission.
Opening the Wizard
From the PA Expirations page, click any row in the table. A panel slides in from the right titled Continue Prior Authorization, showing a summary of the patient, drug, PA number, and how many days remain.
Step 1 — Select Guideline / Indication
The wizard shows the matching guidelines for this patient and drug. If there is only one match, it is pre-selected. If there are multiple (for example, the same drug approved for different indications), select the correct guideline using the radio buttons.
Each option shows the guideline title and indication so you can identify the right one.
Click Next to proceed.
Step 2 — Baseline Review
The system checks whether the guideline’s continuation rules require baseline clinical values and whether those values are already on record for this patient.
If no baseline is required
A green confirmation message appears: No baseline data required — you can proceed. Click Next.
If baseline values are already on record
A green message confirms: Baseline values are on record for all required fields — you can proceed. Click Next.
If baseline values are missing
You see three options to provide the missing values:
- Enter the baseline values manually — expand this panel to type in the required lab values and their observation dates. Dates must be at least 14 days before today to qualify as a baseline. Click Save Baseline Values after entering them.
- Upload a progress note — expand this panel and click Select File to upload a clinical note or lab report. The system extracts the baseline values automatically.
- Proceed without uploading values — if you choose this option, the continuation evaluation will send a data request to the prescriber asking them to provide the missing values. You can complete the evaluation once those values are submitted.
After resolving baseline data (or choosing to proceed without it), click Next.
Step 3 — Confirm & Initiate
Review the summary table before submitting:
| Field | Value shown |
|---|---|
| Patient | Patient name |
| Drug | Medication name |
| Guideline | Selected guideline and indication |
| Expiration Date | When the PA expires |
| Baseline Status | Not required / Ready / Data requests may be needed |
Patients without active therapy
If the patient does not have active paid claims for this medication, a yellow warning appears. You must check the Force evaluation without current therapy box to proceed. The evaluation may result in a data request or initiation determination instead of continuation.
Submitting
Click Start Continuation Evaluation. The system initiates the evaluation immediately.
After You Submit
A green confirmation message appears: Continuation evaluation started! The evaluation is running — results will appear in the patient timeline.
Click View Patient Timeline to open the patient’s chart and see the new prior-authorization task in their timeline. The task will reflect the evaluation’s determination once it completes.