Streamlining Veradigm (Allscripts) Aetna Prior Authorization Automation

Klivira provides comprehensive Veradigm (Allscripts) Aetna prior authorization automation, directly integrating with your EMR to accelerate approvals and reduce administrative burden.

For revenue cycle directors and prior authorization coordinators, managing the complexities of Aetna prior authorizations from within a Veradigm (Allscripts) EMR environment presents unique challenges. Varied submission channels, product-line specific EMR workflows, and the need for meticulous documentation often lead to bottlenecks. Klivira addresses these by providing a unified solution for Veradigm (Allscripts) Aetna prior authorization automation.

Navigating Aetna Prior Authorization Channels from Veradigm (Allscripts)

Aetna, a CVS Health-owned national insurer, utilizes diverse channels for prior authorization submissions. For medical benefit PAs, requests route primarily through the Availity provider portal, which serves as a key multi-payer workspace. Additionally, Aetna supports X12 278 transactions via clearinghouses for specific procedure categories, as detailed on their precertification landing page. Pharmacy benefit PAs, administered through CVS Caremark, typically leverage ePA partners like CoverMyMeds and Surescripts. Klivira's platform is engineered to connect to these varied Aetna touchpoints.

Seamless Integration with Veradigm's EMR Portfolio

Klivira integrates directly with Veradigm's extensive EMR portfolio, including TouchWorks EHR, Professional EHR, and Sunrise. Leveraging the Veradigm Developer Program, our solution utilizes FHIR R4 APIs for US Core resources and supports SMART App Launch for contextual workflows directly within the clinical UI. This deep integration allows for automated extraction of patient, encounter, coverage, and service request data, minimizing manual data entry and ensuring that Aetna's requirements are met with accurate, EMR-sourced information.

Optimizing Key Veradigm (Allscripts) Aetna PA Workflows

Automated data extraction from Veradigm EMRs (TouchWorks, Professional EHR, Sunrise) to populate Aetna PA forms.
Direct submission to Aetna via Availity portal, X12 278, and ePA partners (CoverMyMeds, Surescripts) for pharmacy benefits.
Real-time status updates and communication write-back to the Veradigm patient chart, orders activity, or task lists.
Support for medical PA, pharmacy PA, and inpatient admission notifications across Aetna's commercial and Medicare Advantage lines.
Facilitating adherence to Aetna's Clinical Policy Bulletins (CPBs) by surfacing relevant criteria and documentation needs.

Addressing Veradigm Product Line Nuances for Aetna PAs

The Veradigm portfolio, encompassing TouchWorks, Professional EHR, and Sunrise, presents distinct integration surfaces and chart anatomies. Klivira's approach accounts for these product-line specificities, ensuring that whether your practice uses TouchWorks for specialty care or Professional EHR for smaller ambulatory settings, your Aetna prior authorization workflows are consistently optimized. Our platform adapts to the specific FHIR API capabilities and write-back opportunities available per Veradigm product line, providing a tailored and robust solution.

Policy Adherence and Regulatory Considerations for Aetna

Aetna's utilization management criteria are published in their Clinical Policy Bulletins (CPBs), which are critical for successful prior authorization. Klivira helps your team align documentation with these CPBs. For Aetna's Medicare Advantage and Medicaid managed-care lines (Aetna Better Health), it's important to consider the phased compliance requirements of CMS-0057-F, which mandates specific electronic PA API conformance and decision timeframes. Klivira’s platform is designed to support these evolving regulatory landscapes, helping your organization maintain compliance.

Frequently asked questions

How does Klivira integrate with Veradigm (Allscripts) for Aetna prior authorizations?

Klivira integrates with Veradigm EMRs like TouchWorks, Professional EHR, and Sunrise via the Veradigm Developer Program, utilizing FHIR APIs and SMART App Launch. This allows for secure, patient-contextual data exchange, automating the extraction of clinical and administrative data needed for Aetna PA submissions directly from your EMR.

Which Aetna submission channels does Klivira support for Veradigm users?

Klivira supports Aetna's primary submission channels, including the Availity provider portal for medical PAs, X12 278 transactions for applicable procedures, and ePA partners like CoverMyMeds and Surescripts for pharmacy benefit prior authorizations administered by CVS Caremark.

Can Klivira handle both medical and pharmacy benefit PAs for Aetna from Veradigm?

Yes, Klivira is designed to manage both medical and pharmacy benefit prior authorizations for Aetna. This includes submissions for procedures, imaging, and specialty drugs under the medical benefit, as well as retail and mail-order pharmacy PAs through Aetna's PBM, CVS Caremark, leveraging their ePA partners.

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

Klivira streamlines the process of adhering to Aetna's Clinical Policy Bulletins (CPBs) by helping ensure that the necessary clinical documentation and criteria are captured from your Veradigm EMR. While we don't provide medical advice, our platform helps organize and present the information required by Aetna's policies for a more efficient review.

Does Klivira support write-back of PA status into Veradigm (Allscripts) EMRs?

Yes, Klivira supports write-back capabilities for prior authorization status and communications into your Veradigm EMR. This ensures that your team has up-to-date information directly within the patient chart, orders activity, or task lists, reducing the need to toggle between systems.