Scheduled Reviews

PA ExpirationsLast updated:

Use Scheduled Reviews when a member’s prior authorization was approved outside GEMA, or when a new client sends you a list of members and the dates their authorizations expire. You schedule a review for a future date. On that date it appears in your Due list. Nothing is evaluated and no letters are sent until you open the review and start it.

A scheduled review is a reminder to do work. It does not create a prior authorization, and it does not record an approval for the patient. Scheduled reviews do not appear on the PA Expirations page.

Opening Scheduled Reviews

From the left navigation, select Scheduled Reviews. The page has three tabs:

Tab What it shows
Due Reviews whose due date is today or earlier
Upcoming Reviews that become due on a later date
Needs match Rows that could not be matched to exactly one patient, or that are missing an expire date

Each row shows the patient, the date the authorization expires, the due date, the review type (Continuation or Initiation), the match result, the status, and where the review came from. Select the patient’s name to open the chart. Select anywhere else on the row to open the review. Use Refresh to reload the list.

How the Due Date Works

The due date is the expire date minus a lead time you choose, in days. For example, an expire date of March 31 with a lead time of 30 days is due March 1. If the due date has already passed when you schedule the review, it appears in Due right away.

Scheduling a Review for One Patient

  1. Open the patient’s chart.
  2. Select Schedule a review below the patient summary.
  3. Enter the PA expire date and the Lead time (days before expiry).
  4. Choose the Review type. Continuation is selected for you. Choose Initiation when the patient is starting therapy.
  5. Select Schedule review.

The dialog shows the due date before you save. If an open review already exists for the same patient, expire date, and review type, the new one is saved on the Needs match tab with a note explaining why.

Uploading a Spreadsheet

  1. On Scheduled Reviews, select Upload spreadsheet.
  2. Upload file. Choose a CSV or Excel file. Each row needs the date the member’s authorization expires, plus a member number or a last name and date of birth. GEMA shows how many rows it found and the first few rows.
  3. Match columns. GEMA suggests which column holds each field: PA expire date, member number, person code, first name, last name, and date of birth. Review each suggestion and change any that look wrong. Select Suggest again to try once more. You must choose the PA expire date column and either a member number column or both a last name and a date of birth column.
  4. Settings and preview. Enter the lead time and choose the review type for the whole file. Select Show preview to see how the first rows will be handled. Nothing is saved yet. If you change a setting, select Refresh preview.
  5. Select Schedule reviews. The result shows how many rows were Scheduled and how many Need match, with the reasons.
  6. Select Done.

Rows are accepted even when they cannot be matched. They wait on the Needs match tab.

Fixing Rows on the Needs Match Tab

A row needs a match when no patient is found, more than one patient could be the member, or the row has no expire date or identifying information.

  1. Select the Needs match tab and open a row.
  2. Read the note at the top of the panel that explains why the row is on hold.
  3. Under Match to a patient, select Use this patient next to one of the possible matches, or search by name, member number, or date of birth and select Use this patient on the right person.
  4. If the expire date is wrong or missing, correct it under Review details and select Save changes.

Once a patient is chosen and the row has an expire date, the review moves to Upcoming or Due.

Changing or Canceling a Review

Open a review that is on hold or scheduled to change its PA expire date, Lead time, or Review type. The due date updates as you type. Select Save changes to keep your edits.

Select Cancel review to remove a review from the queue. Canceling does not run an evaluation or send letters.

Starting a Review

Open a review from the Due or Upcoming tab. The Start review section explains what happens when you start:

  • Starting runs an active evaluation for the patient right now. Letters can go out the same day if the chart is incomplete.
  • The expire date on the review is not proof of an approved prior authorization.
  • The review does not include a drug, so you must choose a guideline.
  • A continuation review is skipped unless the patient has current therapy and a valid approval on the chart. Select Force evaluation (ignore PA and therapy requirements) if you need it to run anyway.
  • If the patient already has an open prior authorization for the same drug, GEMA sends you to that authorization instead of starting another evaluation.
  • A scheduled review does not appear on PA Expirations.

To start the review:

  1. Make sure the review is matched to a patient. You cannot start a review that has no patient.
  2. Choose a Guideline. GEMA checks that it has rules for the review type. If it has none, choose a different guideline.
  3. If the patient already has an open prior authorization for the guideline’s drug, a message names the drug and Start review is unavailable. Select Open existing PA to continue the work there.
  4. Otherwise, select Start review, then confirm.

GEMA runs the evaluation and marks the review Started. Select Open the evaluation to follow its progress. If the evaluation starts but the review cannot be marked as started, the panel gives you a link to the evaluation and a Mark as started button to try again.