Prior Authorization Support Agreement
Section 1: Services
RxGranted provides clinical documentation and administrative support services related to prior authorization, including:
- Preparation of prior authorization (PA) letters with clinical justification
- Clinical documentation supporting medical necessity
- Appeal letters for denied prior authorization requests
- Administrative submission of PA requests to payers (Full Service plan only)
- Status tracking and payer follow-up (Full Service plan only)
RxGranted does NOT provide medical care, does NOT make clinical treatment decisions, does NOT act as a healthcare provider to Client's patients, and does NOT prescribe, dispense, or administer medications. All clinical decisions remain solely with the treating provider. RxGranted provides documentation and administrative support services only.
Section 2: Service Plans and Pricing
- Up to 8 PA letters per month
- All medical specialties covered
- Appeal support included if denied
- PharmD-reviewed clinical documentation
- 24-hour turnaround guaranteed
- Client submits completed letters to payer
- Up to 15 PA cases per month
- Everything in Core, plus:
- RxGranted submits PA requests directly to payer on Client's behalf
- Real-time tracking and payer follow-up
- Appeal filing and payer communication included
- Dedicated PharmD support
Additional Cases
- Core plan: $35 per additional PA letter
- Full Service plan: $50 per additional PA case (includes submission)
Free Trial
Client's first two (2) PA letters are provided at no cost, with no credit card required, to evaluate service quality before committing to a paid plan.
Section 3: Turnaround and Delivery
- Standard requests: Completed within 24 hours of receipt of all required clinical information
- Urgent requests: Same-day completion when feasible; prioritized on Full Service plan
- Turnaround begins when RxGranted receives complete and accurate patient information, clinical documentation, and insurance details
Section 4: Client Responsibilities
Client agrees to:
- Provide accurate and complete patient demographics, clinical data, insurance information, and supporting documentation
- Maintain all provider-patient relationships and clinical decision-making authority
- Submit completed PA letters to the appropriate payer (Core plan)
- Grant and maintain necessary system access for RxGranted to perform submissions (Full Service plan)
- Execute a HIPAA Business Associate Agreement prior to sharing any Protected Health Information
- Notify RxGranted promptly of any changes to patient information, payer requirements, or access credentials
Section 5: Access Authorization (Full Service Plan)
For Full Service clients, Client may authorize RxGranted to access one or more of the following systems for the purpose of PA submission, tracking, and follow-up:
- Electronic Medical Records (EMR/EHR) system
- Availity portal
- CoverMyMeds portal
- Payer-specific portals
- Secure fax (via Doximity or equivalent HIPAA-compliant service)
RxGranted acts strictly as an authorized administrative delegate of Client. Access credentials provided by Client remain Client's property and will be used solely for the purposes described in this Agreement. RxGranted shall not access, modify, or disclose any patient records beyond what is necessary to perform PA-related services.
Section 6: Payment Terms
- All plans are billed monthly in advance
- Payment is due upon receipt of invoice
- No long-term contract required — Client may cancel at any time
- No refunds are issued for completed work or partial months
- Additional PA cases beyond plan limits are invoiced monthly in arrears
- RxGranted reserves the right to suspend services for accounts more than thirty (30) days past due
Section 7: Liability and Disclaimers
- RxGranted is not responsible for payer coverage decisions. Approval of any prior authorization request is ultimately determined by the patient's insurance company
- RxGranted does not guarantee that any PA request will be approved
- RxGranted shall not be liable for delays caused by incomplete or inaccurate information provided by Client
- Except in cases of gross negligence, willful misconduct, or breach of PHI, RxGranted's total liability under this Agreement shall not exceed the aggregate fees paid by Client in the twelve (12) months preceding the event giving rise to liability
- Client acknowledges that RxGranted's role is limited to documentation and administrative support, and that all clinical decisions remain with Client
Section 8: HIPAA Compliance
The Parties agree to execute a Business Associate Agreement ("BAA") prior to the exchange of any Protected Health Information. The BAA, attached hereto or executed separately, is incorporated into this Agreement by reference. Both Parties shall comply with all applicable provisions of the HIPAA Privacy Rule, Security Rule, and Breach Notification Rule.
Section 9: Confidentiality
Each Party agrees to maintain the confidentiality of the other Party's proprietary information, business methods, pricing, and operational procedures. This obligation survives termination of this Agreement for a period of two (2) years.
Section 10: Term and Termination
- This Agreement is effective as of the Effective Date and continues on a month-to-month basis until terminated
- Either Party may terminate this Agreement at any time by providing written notice
- Upon termination, RxGranted shall complete any PA cases in progress at the time of notice and return or destroy all PHI per the BAA
- All system access granted to RxGranted shall be revoked immediately upon termination
- Sections 7, 8, 9, and this Section 10 survive termination
Section 11: Governing Law
This Agreement shall be governed by the laws of the State of New Jersey, without regard to conflict of law principles, to the extent not preempted by federal law.
Section 12: Entire Agreement
This Agreement, together with the BAA, constitutes the entire agreement between the Parties regarding the subject matter hereof. No modification shall be effective unless in writing and signed by both Parties.