FAQ

SUPPORT

Frequently asked questions

Core Functionality

Integration + Compatibility

Payer + Compliance

Data Handling + Security

Performance + Impact

Core Functionality

Does the platform support real-time electronic prior authorization (ePA)?

Yes. Ethermed fully supports real-time ePA via eFax, payer portals, and will fully support the payer APIs mandated by CMS-0057-F (CMS Interoperability and Prior Authorization final rule). Our process accuracy has contributed to a 50% reduction in turnaround time by enabling payers to approve sooner.

How does Ethermed handle specialty drug prior authorization workflows?

We manage complex specialty drug workflows, varying by drug and payer, including multi-step (“step edit”) processes. Dynamic form logic ensures that each submission meets the exact requirements for that drug and payer.

Does Ethermed offer appeals management?

Yes. Ethermed supports re-submission, automated appeal generation, peer-to-peer review summaries, denial defense letters, and payer-specific templates. These workflows are designed to minimize manual intervention and speed resolution.

How does Ethermed answer questions on payer websites before an authorization number is assigned?

Ethermed automates this step through direct payer portal integration and policy-trained AI. We retrieve payer-specific question sets and pre-fill them using patient demographics, clinical data, and codes from connected EHRs and document repositories. Our AI is pre-trained on over 100,000 policies across 186 payers, enabling accurate completion before an authorization number is issued.

Integration + Compatibility

Can Ethermed integrate with CoverMyMeds and Surescripts?

Yes. We integrate with both and complement their workflows, accelerating patient access to therapy.

Does Ethermed integrate with PMSs, HUBs, or CRMs like Salesforce?

Yes. Our APIs support secure push/pull data exchange with third-party applications, including PMSs, HUBs, and CRMs.

How are authorization numbers or no-auth-needed notices loaded into client systems?

Through a combination of secure portal access, API integrations, and document ingestion, Ethermed writes these outcomes back into the client’s systems (EHR, PMS, or claims platform) to ensure they’re linked to the claim.

Payer + Compliance

Does Ethermed have direct payer connections beyond intermediaries?

Yes. We have direct API/EDI connections with 186 payers nationwide and are pre-trained on 100,000+ policies.

How does Ethermed track denials and handle follow-up?

Our system automatically flags pending and denied authorizations, tracks response timelines, and triggers resubmission workflows. Denials are analyzed to identify missing or incorrect elements, corrected using our Clinical Review process, and resubmitted automatically when possible. When automation is not possible, a Clinical Reviewer document highlights exactly what is needed for human follow-up.

How does Ethermed recognize and respond to changing payer policies?

Our Policy and Form Repository monitors policy and form changes daily. Detected changes trigger AI tuning and are flagged for review by our Clinical Policy Team, who conduct quality assurance before updates are pushed live — typically within days.

Data Handling + Security

Is Ethermed HIPAA or HITRUST certified?

We are HIPAA compliant and SOC 2 certification is in process.

How is clinical documentation intake and storage handled?

Documentation is securely received via EHR integration, fax, or upload, and stored encrypted in transit and at rest.

Is client data stored separately from other customers?

Yes. Each client has its own tenant with dedicated, isolated storage. No data is shared across clients. De-identified data may be used to enhance product performance.

Performance + Impact

What percentage of PA submissions are fully automated?

Current clients achieve 89% full automation (no human touch) and 91% first-time approval success across 4.8 million prior authorizations processed annually.

What impact does Ethermed have on turnaround time?

We have reduced PA turnaround times by 50% due to the completeness and accuracy of our submissions, enabling faster payer decisions and patient access to care.

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