Streamlining Veradigm (Allscripts) Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers intelligent Veradigm (Allscripts) Anthem (Elevance Health) prior authorization automation, bridging the gap between your EMR and one of the nation's largest payers to expedite approvals and enhance revenue cycles.

For revenue cycle directors and prior authorization coordinators, navigating the complexities of submitting PAs from Veradigm EMRs (including TouchWorks and Professional EHR) to Anthem (Elevance Health) can be a significant operational burden. The manual effort involved in extracting clinical data, logging into disparate payer portals like Availity, or managing ePA through third-party platforms often leads to delays, increased administrative costs, and potential claim denials.

The Challenge: Veradigm EMR to Anthem PA Submissions

Clinics and small hospitals utilizing Veradigm's ambulatory and inpatient EMR solutions frequently face bottlenecks when securing prior authorizations from Anthem (Elevance Health) for their members. The workflow typically involves manually transcribing patient and clinical data from TouchWorks or Professional EHR into Anthem's designated submission channels, which include the multi-payer Availity portal, or engaging with ePA partners for pharmacy benefits.

Klivira's Integration with Veradigm EMRs

Klivira integrates directly with Veradigm EMRs, including TouchWorks and Professional EHR, leveraging the Veradigm developer program and FHIR API. This robust integration enables seamless, bi-directional data exchange, allowing Klivira to intelligently extract necessary patient demographics, clinical notes, and order details directly from the EMR. This eliminates manual data entry, reducing errors and saving significant staff time.

Navigating Anthem's Prior Authorization Channels

Anthem (Elevance Health) utilizes a multi-pronged approach for prior authorization submissions. Klivira automates interaction with these channels, including direct submission via X12 278, intelligent navigation of the Availity portal for medical benefits, and integration with Anthem's ePA partners, CoverMyMeds and Surescripts, for pharmacy benefits. Our platform ensures that each authorization request is routed correctly and efficiently, adhering to Anthem's specific requirements.

Optimizing Key PA Workflows for Veradigm-Anthem Pairings

Our automation specifically targets high-volume and high-complexity prior authorization workflows common for practices using Veradigm EMRs and serving Anthem members. This includes specialty drug ePA for conditions requiring biologics or GLP-1s, advanced imaging (e.g., MRI, CT scans) often subject to Anthem's medical necessity criteria, and surgical procedure authorizations. By automating these processes, Klivira helps ensure all necessary clinical documentation is accurately submitted, reducing the likelihood of denials.

Achieving Operational Efficiency and Faster Approvals

Implementing Klivira for Veradigm (Allscripts) Anthem (Elevance Health) prior authorization automation translates directly into tangible benefits. Clinics and hospitals can expect reduced administrative overhead, improved PA turnaround times, and a decrease in prior authorization-related denials. This operational efficiency allows your staff to focus on patient care rather than burdensome manual tasks, ultimately enhancing patient satisfaction and financial performance.

Frequently asked questions

How does Klivira integrate with Veradigm EMRs like TouchWorks and Professional EHR?

Klivira integrates with Veradigm EMRs through the Veradigm developer program, leveraging FHIR APIs for secure and efficient data exchange. This allows our platform to pull relevant patient and clinical data directly from your EMR to populate prior authorization requests, minimizing manual data entry.

Which Anthem (Elevance Health) prior authorization channels does Klivira support?

Klivira supports all primary Anthem prior authorization channels. This includes electronic submission via X12 278, automated interaction with the Availity portal for medical benefits, and integration with Anthem's ePA partners, CoverMyMeds and Surescripts, for pharmacy benefit authorizations.

Can Klivira automate specialty drug prior authorizations for Anthem members?

Yes, Klivira automates specialty drug ePA for Anthem members by integrating with their preferred ePA partners, CoverMyMeds and Surescripts. This streamlines the complex process for high-cost medications, including biologics and GLP-1s, ensuring timely submission of necessary clinical documentation.

What kind of data does Klivira extract from Veradigm for Anthem PA submissions?

Klivira extracts essential data points from your Veradigm EMR, such as patient demographics, diagnosis codes, procedure codes, clinical notes, lab results, and medication lists. This comprehensive data capture ensures that all information required by Anthem for a prior authorization request is accurately and completely submitted.

How does Klivira impact prior authorization turnaround times for Anthem requests?

By automating data extraction, form submission, and status monitoring, Klivira significantly reduces the manual steps involved in prior authorization. This operational efficiency leads to faster submission of requests to Anthem and quicker identification of approval statuses, ultimately improving overall PA turnaround times.