Veradigm (Allscripts) Alignment Health Prior Authorization Automation

Achieve seamless Veradigm (Allscripts) Alignment Health prior authorization automation with Klivira. Our platform directly integrates with your Veradigm EMR to streamline submissions to Alignment Health, enhancing efficiency and patient care.

Navigating prior authorizations for Medicare Advantage plans, particularly with payers like Alignment Health, presents unique challenges for healthcare providers using Veradigm EMRs. The manual burden of submitting requests, tracking statuses, and managing denials impacts revenue cycles and diverts clinical staff from patient care. Klivira addresses these operational inefficiencies by automating critical steps in the PA workflow.

The Challenge: Alignment Health PAs from Veradigm EMRs

Providers leveraging Veradigm EMRs, including TouchWorks EHR and Professional EHR, face significant administrative overhead when processing prior authorizations for Alignment Health's Medicare Advantage plans. This often involves manual data extraction from the patient chart, navigating payer-specific portals, and reconciling disparate information, leading to delays and potential revenue leakage. The complexity is compounded by Alignment Health's focus on senior care, often involving intricate medical policies for specific services and medications.

Klivira's Direct Integration with Veradigm (Allscripts) EMRs

Klivira connects directly with your Veradigm EMR environment through the Veradigm Developer Program, leveraging modern FHIR APIs and SMART App Launch capabilities. This integration enables automated data exchange, allowing Klivira to securely pull necessary clinical and administrative data—such as Patient, Encounter, Coverage, and ServiceRequest details—from your TouchWorks EHR, Professional EHR, or Sunrise system. Our platform is designed to operate seamlessly within your existing clinical workflows, minimizing disruption.

Streamlining Prior Authorizations for Alignment Health

Automated data extraction from Veradigm product lines (e.g., TouchWorks EHR, Professional EHR) to pre-populate Alignment Health PA requests.
Direct submission to Alignment Health via electronic prior authorization (ePA) channels or intelligent portal automation.
Real-time status updates and payer correspondence pushed back into the Veradigm chart, often surfacing in Tasks or Worklists.
Reduction in manual portal logins and data re-entry for Alignment Health submissions, freeing up PA coordinators.
Support for Medicare Advantage-specific PA requirements, helping to navigate Alignment Health's policy nuances.

Addressing Medicare Advantage Complexities with Alignment Health

Alignment Health's specialized focus on Medicare Advantage plans often translates to specific prior authorization requirements for high-cost services and specialty medications. Klivira's automation platform is configured to adapt to these nuances, ensuring that requests for services like advanced imaging, surgical procedures, or specialty medications (e.g., biologics, high-cost injectables) are submitted with the complete clinical documentation Alignment Health requires. This proactive approach helps reduce denials and accelerates approval times.

Enhanced Workflow for Veradigm Ambulatory and Inpatient Settings

Whether your organization utilizes Veradigm's ambulatory solutions like TouchWorks EHR and Professional EHR or the inpatient Sunrise platform, Klivira adapts to the distinct chart anatomies and workflows. For ambulatory practices, PA packets and status updates can be deposited into Clinical Documentation or Notes. In inpatient settings, Klivira integrates with orders activity and worklists, ensuring that prior authorization processes are embedded where clinicians place orders that may trigger PA requirements for Alignment Health.

Frequently asked questions

How does Klivira integrate with my Veradigm EMR for Alignment Health PAs?

Klivira integrates with Veradigm EMRs, including TouchWorks EHR, Professional EHR, and Sunrise, via the Veradigm Developer Program. We utilize FHIR R4 APIs for secure data exchange and support SMART App Launch for contextual workflows. This allows Klivira to pull necessary patient and clinical data and push status updates back into your EMR.

Can Klivira handle all types of prior authorizations for Alignment Health?

Klivira supports a comprehensive range of prior authorizations for Alignment Health, covering medical services, procedures, and pharmacy benefits (ePA). Our platform is designed to manage the complexities of Medicare Advantage plans, ensuring that requests meet payer-specific requirements and documentation standards for various service lines.

How are prior authorization status updates managed within Veradigm?

Klivira automatically retrieves status updates from Alignment Health and pushes them directly back into your Veradigm EMR. These updates typically appear within the patient's chart, often routed to Tasks or Worklists, and can include payer correspondence or peer-to-peer scheduling information. This ensures your team has real-time visibility without leaving the EMR.

Does Klivira support both TouchWorks EHR and Professional EHR for Alignment Health PAs?

Yes, Klivira is designed to integrate with multiple Veradigm product lines, including TouchWorks EHR and Professional EHR. We account for the operational and technical distinctions between these systems, ensuring a tailored and effective prior authorization automation solution for your specific Veradigm environment when submitting to Alignment Health.

What data does Klivira pull from my Veradigm EMR for Alignment Health submissions?

Klivira securely pulls a range of PA-relevant data from your Veradigm EMR using FHIR APIs. This includes resources such as Patient demographics, Encounter details, Coverage information, ServiceRequest and MedicationRequest specifics, DocumentReference for clinical notes, Practitioner details, Condition diagnoses, and Observation results, ensuring comprehensive submission packets for Alignment Health.