Workflow Overview

Single-Point Referral
Intake via Hub

A fully branded, end-to-end workflow covering referral intake, benefits investigation, prior authorization, copay processing, and real-time analytics — all through one unified hub.

Fully Branded Real-Time Analytics Automated PA ACH Payments

Single-Point Referral Intake via Hub

Prescriber Sends Referral
eScribe
EMR
Via Pharmacy
Direct
Prescriber Portal
Web-based
Hub (Phone & Fax)
Direct intake
Medmonk
Branded Hub · All channels unified
Electronic &/or Manual BI
Benefits Investigation
Provider Pinged
New patient & status updates on portal
Welcome Call
Within 4–6 hours
Send Opt-In Text
Real-time patient consent SMS
👤
Patient
Opt-In
IF Not
Support call after
24hr, 48hr, 72hr
Automated PA Initiation
Auto-generated LMN based on DX & payor guidelines. No manual drafting.
Unique Link to Prescriber
For review & approval, then electronically submitted to primary payor
PA
Approved
IF Not Approved
PA follow-up for status or appeal
Patient Packet Uploaded
On provider portal
Manufacturer Portal
Real-time analytics: BI, PA, dispensing, refills, prescribers, copay
Pharmacy Copay Claim
NCPDP Secondary Payor
Provider processes to Medmonk as secondary payor via NCPDP in <3 seconds
Medical Copay Claim
Provider uploads EOB or receives 835 via clearing house
Upload EOB
Upon receipt
Auto 835
Via clearing house
Real-Time Analytics
Timestamps: BI, PA, dispensing, refills, prescribers, copay
Process ACH Payments
Post remittance on provider portal
*All portals branded to manufacturer  ·  *Provider represents Specialty Pharmacy and Buy & Bill Facilities
Step 1

Prescriber Sends Referral

Prescriber Sends Referral
eScribe
EMR
Via Pharmacy
Direct
Prescriber Portal
Web-based
Hub (Phone & Fax)
Direct intake
Medmonk
Branded Hub · All channels unified
Step 2

Four Parallel Actions Fire Simultaneously

Upon referral receipt, Medmonk triggers all four actions at once — no delays, no manual hand-offs.

Provider Pinged

Prescriber notified instantly for every new patient with real-time status updates on the provider portal.

Welcome Call

Personal patient welcome call placed within 4–6 hours of referral receipt.

Benefits Investigation

Electronic and/or manual BI performed immediately to determine coverage and full eligibility.

Patient Opt-In Text

Real-time SMS for consent. No response triggers follow-ups at 24hr, 48hr, and 72hr.

Step 3

Automated PA Initiation

Electronic &/or
Manual BI
Benefits Investigation
PA Automation

Medmonk auto-generates a Letter of Medical Necessity (LMN) based on the patient's diagnosis (DX) and payor-specific guidelines — no manual drafting required.

A unique link is sent to the prescriber for digital review and one-click approval, then electronically submitted to the primary payor.

Auto-generated LMNDX-Based LogicPayor GuidelineseSubmission
Step 4

PA Decision Point

Medmonk actively monitors PA status in real time. Every outcome has an immediate next action.

Approved?
If Approved ✓

Patient packet uploaded to provider portal. Data synced to Manufacturer Portal for complete real-time visibility.

Packet UploadedPortal Synced
If Not Approved ✗

Immediate PA follow-up initiated — status check with the payor or formal appeal filed on behalf of the patient.

Status CheckAppeal Filed
Analytics
Step 5

Centralized Data & Analytics

All workflow data available in the Manufacturer Portal — complete real-time visibility across every stage of the patient journey.

Every touchpoint timestamped and tracked:

BIPrior AuthDispensingRefillsCopayPrescribers
Step 6

Copay Claims Processing

Two parallel claim tracks run simultaneously to ensure complete copay coverage for both pharmacy and medical benefit patients.

Pharmacy Copay Claim
NCPDP Secondary Payor
Provider processes claim to Medmonk as secondary payor via NCPDP — adjudicated in <3 seconds.
Medical Copay Claim
EOB Upload or 835 Auto-Receipt
Upload EOB
Provider uploads Explanation of Benefits upon receipt.
Auto 835
Automated 835 file received via clearing house.
Step 7

ACH Payment & Remittance

ACH payments processed and remittance posted directly on the provider portal — closing the complete financial loop from referral to reimbursement.

ACH ProcessingRemittance PostingProvider PortalFull Audit Trail
Full Workflow Closed
Referral BI PA Claims ACH ✓
The Medmonk Advantage

Why Single-Point Intake?

Fast PA

Auto-generated LMN & electronic submission — no manual drafting

One Hub

Single branded entry point for all referral channels

Live Analytics

Real-time timestamps across every touchpoint in the workflow

Dual Claims

Pharmacy NCPDP <3s + Medical EOB/835 processed in parallel

ACH Closed Loop

Payments & remittance posted directly to provider portal

Fully Branded

All portals & communications branded to the manufacturer

*Provider represents Specialty Pharmacy and Buy & Bill Facilities