AdvancedMD Aetna Prior Authorization Automation for Ambulatory Practices

Klivira delivers comprehensive AdvancedMD Aetna prior authorization automation, specifically designed to integrate with your ambulatory practice's EMR and navigate Aetna's diverse submission channels.

For revenue cycle directors and prior authorization coordinators at ambulatory specialty practices utilizing AdvancedMD, managing Aetna's varied prior authorization requirements often involves significant manual effort. From navigating the Availity portal to understanding specific Clinical Policy Bulletins (CPBs) and coordinating pharmacy benefit submissions, the complexity can impede patient care and revenue integrity.

Connecting Klivira with AdvancedMD for Seamless Data Exchange

Klivira integrates directly with AdvancedMD via the AdvancedMD API, establishing a secure, bidirectional data flow. This integration ensures that patient demographics, clinical documentation, and order details required for prior authorizations are automatically extracted from your AdvancedMD EHR, eliminating repetitive data entry and reducing the risk of errors.

Navigating Aetna's Diverse Prior Authorization Channels

Aetna's prior authorization requirements are managed through multiple distinct channels, depending on the benefit category and service type. Klivira's platform is engineered to connect to these varied endpoints, providing a unified workflow for your team regardless of Aetna's specific routing.

Aetna Submission Channels Supported by Klivira

**Medical Benefit PA:** Automation via the Availity provider portal, Aetna's primary multi-payer provider workspace.
**X12 278 Transactions:** Direct electronic submission for eligible medical procedures and inpatient admission notifications.
**Pharmacy Benefit PA:** Integration with CoverMyMeds and Surescripts ePA for outpatient retail pharmacy authorizations.
**Specialty Drug PA:** Streamlined workflows to address medical-benefit specialty medications, often requiring distinct management.

Automating Aetna Clinical Policy Bulletin (CPB) Adherence

Aetna's medical necessity criteria are detailed in its Clinical Policy Bulletins (CPBs), published in the public Aetna CPB library. Klivira helps your team adhere to these guidelines by providing contextual access to relevant CPBs and structuring authorization requests to align with Aetna's specific documentation requirements, such as those for advanced imaging or specialty biologics.

Compliance and Turnaround Time Considerations for Aetna PAs

Klivira helps practices align with state-mandated turnaround times and payer-published service-level targets for Aetna authorizations. For Aetna's Medicare Advantage and Medicaid managed-care lines (Aetna Better Health), Klivira supports compliance with CMS-0057-F requirements, which mandate 72-hour decisions for standard PA requests and 24-hour decisions for expedited requests, as these phased compliance timelines progress.

Frequently asked questions

How does Klivira integrate with AdvancedMD?

Klivira integrates with AdvancedMD through its robust AdvancedMD API. This allows for secure, real-time extraction of patient data, clinical notes, and order details directly from the EMR, populating prior authorization requests without manual data entry.

Which Aetna prior authorization channels does Klivira support?

Klivira supports a comprehensive range of Aetna prior authorization channels, including direct submission via the Availity provider portal for medical benefits, X12 278 electronic transactions, and integrations with ePA partners like CoverMyMeds and Surescripts for pharmacy benefits.

Does Klivira help with Aetna's Clinical Policy Bulletins (CPBs)?

Yes, Klivira assists in navigating Aetna's Clinical Policy Bulletins (CPBs). The platform helps structure prior authorization requests to align with Aetna's specific medical necessity criteria and documentation requirements, drawing from the public Aetna CPB library.

Can Klivira handle Aetna's pharmacy benefit prior authorizations?

Absolutely. For Aetna's pharmacy benefit prior authorizations, Klivira integrates with leading ePA partners such as CoverMyMeds and Surescripts, streamlining submissions for outpatient retail and mail-order prescriptions administered through CVS Caremark.

How does Klivira address CMS-0057-F for Aetna's Medicare Advantage plans?

Klivira helps practices meet the requirements of CMS-0057-F for Aetna's impacted lines of business, such as Medicare Advantage and Medicaid managed-care. The platform is designed to support the mandated electronic prior authorization API conformance and decision-timeframe requirements as they come into effect.