Appeals
When a prescriber or patient contests a prior authorization determination, an appeal task is created for your team to review.
Appeal controls apply to prior authorization determinations. A Therapeutic Interchange or Legacy Therapy Discontinuation rejection instead shows read-only 30-day refill-block status and does not offer PA approval, denial, or appeal controls on that child task.
Finding Appeal Tasks
From the left navigation, select Tasks. Open the Task Type dropdown and select Appeals. The queue now shows only appeal review tasks. Your type filter (and other queue filters) remain in place if you open a task and press the browser Back button.
Each appeal task row shows the patient name, the task status (for example, Open or Completed), the due date, and the associated medication.
Select a row (or the eye icon) to open the linked patient’s chart when a patient is available. An open appeal opens on the Overview tab focused on that task. A closed appeal opens on the Tasks tab with its parent PA history expanded. If the appeal has no resolvable patient, the queue opens the standalone task details page instead. Appeal approval and denial happen on the task details page, described below.
The Appeal Review Card
On the appeal task details page you will see the Appeal Review card at the top. Three chips indicate:
- Appeal type — Either Internal or External.
- Requested turnaround — Standard (30 days) or Expedited (72 hours), as chosen by the submitter. This is independent of internal versus external. Appeals filed before turnaround was captured show as standard.
- Appeal status — Open (pending review), Approved, or Denied.
Below the header, the task detail page contains two informational sections followed by a resolution panel if the appeal is still open.
Patient & Prior Authorization
This section shows:
| Field | Description |
|---|---|
| Patient | The patient’s name, linked to their chart |
| Medication | The drug under appeal |
| Prior Authorization | A View PA Workflow Timeline button that opens the parent PA task so you can review the full history |
If there is no parent PA on file, this field reads No parent PA.
Appeal Submission
This section contains the information submitted by the prescriber or external party:
| Field | Description |
|---|---|
| Submitted By (NPI) | The NPI number of the submitting provider |
| Submitted On | The date and time the appeal was filed |
| Requested Turnaround | Standard (30 days) or Expedited (72 hours) |
| Provider Commentary | The prescriber’s written explanation for the appeal |
| Supporting Documents & Literature | Downloadable documents attached to the appeal submission, including any published studies or clinical literature the prescriber uploaded |
Select a document in the Supporting Documents & Literature list to download and review it. Patient records and published literature arrive in the same list.
Approving or Denying an Appeal
When the appeal status is Open, a Resolve Appeal panel appears at the bottom of the task. You may optionally enter Resolution Notes (up to 2,000 characters) to document your reasoning. Then select either:
- Approve Appeal — to uphold the prescriber’s appeal and reverse the determination.
- Deny Appeal — to affirm the original determination.
A confirmation dialog appears asking you to confirm the action. Select Approve or Deny to finalize, or Cancel to go back.
After resolution, the status chip changes to Approved or Denied, and a Resolution section appears showing the outcome, who resolved it, and when.
Like other task detail pages, Related Items may show links to the related evaluation and to outbound letters (View Outbox Item) when those exist for the task.
The Approve Appeal and Deny Appeal buttons are visible to any user with access to the task. Your organization may have internal policies about which roles are authorized to make final appeal decisions.