Single-Point Referral
Intake via Hub

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

Manufacturer Branded Real-Time Analytics Automated PA ACH Payments

All portals branded to manufacturer  ·  Supports Specialty Pharmacy & Buy & Bill Facilities

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

Pharmacy Initiates Four Parallel Actions

Provider Pinged

Notified for every new patient with real-time status updates on the provider portal.

Welcome Call

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

Benefits Investigation

Electronic and/or manual BI to determine coverage and eligibility.

Patient Opt-In Text

Real-time SMS for consent. No response: follow-up at 24hr, 48hr, 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 submitted to the prescriber for digital review and approval, then the PA is electronically submitted to the primary payor.

Auto-generated LMN DX-Based Logic Payor Guidelines eSubmission
Step 4

PA Decision Point

Approved?
If Approved

Patient packet uploaded to provider portal. Data synced to Manufacturer Portal.

If Not Approved

PA follow-up initiated for status check or formal appeal with payor.

Analytics
Step 5

Centralized Data & Analytics

All workflow data available in the Manufacturer Portal for full real-time visibility across the patient journey.

Timestamps tracked across every touchpoint:

BIPrior AuthDispensingRefillsPrescribersCopay
Step 6

Copay Claims Processing

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

Pharmacy Copay Claim
NCPDP Secondary Payor
< 3 seconds
Provider processes claim to Medmonk as a secondary payor via NCPDP
<3s
Processing
Medical Copay Claim
EOB or 835 via Clearing House
Option A — Upload EOB
Provider uploads Explanation of Benefits upon receipt
— OR —
Option B — Automated 835
Receives automated 835 remittance via clearing house
Step 7

ACH Payment & Remittance

ACH payments processed and remittance posted directly on the provider portal — closing the full financial loop.

ACH ProcessingRemittance PostingProvider Portal
The Medmonk Advantage

Why Single-Point Intake?

Fast PA

Auto-generated LMN & electronic submission

One Hub

Single branded entry for all channels

Real-Time Data

Timestamps across BI, PA & copay

<3 Sec Claims

NCPDP pharmacy copay via secondary payor

All portals branded to manufacturer  ·  Supports Specialty Pharmacy & Buy & Bill Facilities

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