The goal of this guide is to provide up-to-date information and best practices for coding, billing, and denial resolution for PrEP and PEP services. Health department staff are encouraged to share this resource with grantees, community partners, and other health care providers billing for HIV prevention services.

Identifying candidates for PrEP can be challenging but not impossible. The first step to finding the right candidates involves understanding the criteria for PrEP. Not everyone is a great candidate for PrEP or can adhere to the frequent testing and monitoring required of PrEP patients. Some patients are comfortable using condoms and other HIV prevention methods, and providers should respect and affirm their decision.

Health centers are increasingly interested in embedding oral Pre-Exposure Prophylaxis (PrEP) programs into primary care, which calls for the embedding of PrEP care processes into electronic health record (EHR) systems. Health centers have had success with automation in HIV testing, and are looking to apply automated algorithms, order sets, and templates to the development of PrEP programs. This resource outlines EHR and health information technology (IT) configurations and tools that support PrEP care processes and provides examples of successful implementation from health centers and primary care settings.

With nearly 100% of community health centers utilizing electronic health records (EHR) to care for patients, focus has pivoted from implementation and new workflow development to enhancement in order to drive value and reflect patient needs and population trends. EHR technology presents potential opportunities and significant constraints. Providers frequently document and share potentially sensitive information in the EHR, such as risk for intimate partner violence (IPV), consistent offers of pre-exposure prophylaxis (PrEP), or patient sexual orientation and gender identity (SOGI). Capturing such information can be immensely helpful in providing care tailored to individuals’ needs, but additionally challenges teams to develop workflows that keep the data private rather than risk harm to patients through improper or unintended disclosure.

This resource is an example of a Pre-Exposure Prophylaxis (PrEP) Process Map. Process maps can be used to document health center workflows.
 

What if we told you your electronic health record (EHR) was one of the keys to ending the HIV epidemic (EHE)? Your EHR is a powerful tool that can support increases in HIV testing, access to pre-exposure prophylaxis (PrEP) for people at risk for HIV, and so much more! View our HITEQ Highlights webinar on June 8th to learn more about leveraging your EHR through the use of digital tools and innovative strategies!

As health centers integrate PrEP for HIV prevention into their primary care services, it is important to align with the latest guidance and research. The PrEP checklist from UNC School of Medicine's North Carolina HIV Training & Education Center offers step-by-step detailed guidance for providing PrEP. This checklist can be used to inform workflow, EHR, and other health IT updates including order sets and clinical decision support. It can also be used as a reference for providers who are newer to providing PrEP who are prompted or alerted to a patient's potential need for HIV prevention services.

Primary care plays a key role in ending the HIV epidemic. The Ending the HIV Epidemic initiative launched across HHS in 2019, setting forth four key strategies also called the “four pillars” of ending the HIV epidemic. Primary care in federally qualified health centers figures centrally into these efforts, evidenced by the addition of several HIV screening and prevention measures and metrics in the Uniform Data System (UDS) reporting. This webinar reviewed the outcomes of the first year of HIV Screening and Prevention reporting on the UDS, highlight opportunities for quality improvement, and discussed funding opportunities.