Streamlining Veradigm (Allscripts) BCBS Arizona Prior Authorization Automation

Klivira optimizes Veradigm (Allscripts) BCBS Arizona prior authorization automation, significantly reducing manual effort and accelerating approvals for healthcare providers in Arizona.

Navigating prior authorizations for Blue Cross Blue Shield of Arizona (BCBSAZ) while operating within the Veradigm (formerly Allscripts) EMR ecosystem presents unique operational challenges. Revenue cycle and prior authorization teams frequently encounter bottlenecks from disparate systems, manual data entry, and varied payer requirements. Klivira provides a purpose-built solution to bridge these gaps.

The Challenge: Veradigm EMR Workflows and BCBS Arizona PA Submissions

Healthcare organizations utilizing Veradigm's portfolio—including TouchWorks EHR, Professional EHR, and Sunrise—often face a multi-step process to secure prior authorizations from BCBS Arizona. This typically involves extracting clinical data from the EMR, manually inputting information into the Availity portal, and tracking statuses across systems. This fragmented workflow can lead to delays, increased administrative burden, and potential claim denials.

Klivira's Integration with Veradigm (Allscripts) EMRs

Klivira integrates directly with Veradigm EMR platforms to streamline prior authorization workflows. Leveraging the Veradigm Developer Program and FHIR R4 APIs, Klivira accesses necessary patient, encounter, coverage, and service request data from your EMR. For modern Veradigm product lines, SMART App Launch capabilities enable a seamless, patient-contextualized experience directly from the clinical UI, minimizing context switching for clinicians and PA coordinators. Klivira's integration accounts for the distinct integration surfaces of TouchWorks EHR, Professional EHR, and Sunrise.

Automating BCBS Arizona Prior Authorizations via Availity

BCBS Arizona primarily utilizes the Availity portal for electronic prior authorization submissions. Klivira automates the interaction with the Availity portal, eliminating the need for manual data entry. Our platform intelligently populates forms, attaches required clinical documentation (e.g., via FHIR DocumentReference resources), and submits authorization requests directly to BCBSAZ. This ensures consistency, reduces human error, and accelerates the submission process for all types of services, from specialty medications to advanced imaging and surgical procedures.

Optimizing Prior Authorization Workflows for Veradigm Users

By connecting your Veradigm EMR directly to BCBS Arizona's submission channels, Klivira transforms the prior authorization process. Our solution automates the initiation of PA requests based on orders placed in your EMR's orders activity, intelligently routes requests, and provides real-time status updates. This proactive approach helps reduce turnaround times and improves the efficiency of your prior authorization team, allowing them to focus on complex cases rather than repetitive data entry.

Key Benefits for Your Organization:

Automated data extraction from Veradigm EMRs (TouchWorks, Professional EHR, Sunrise).
Direct electronic submission to BCBS Arizona via Availity portal.
Reduced manual data entry and administrative overhead.
Improved visibility into PA status within your existing workflows.
Accelerated prior authorization turnaround times.
Enhanced data accuracy and compliance considerations for HIPAA and PHI.

Compliance and Data Security

Klivira's platform is designed with robust security protocols to protect sensitive patient health information (PHI) in transit and at rest. Our integrations adhere to industry standards for data exchange, including FHIR, ensuring secure communication between your Veradigm EMR and payer systems. Organizations should consult with their compliance teams to ensure all aspects of data handling align with their specific policies and regulatory requirements.

Frequently asked questions

How does Klivira handle different Veradigm (Allscripts) product lines?

Klivira's integration is designed to accommodate the distinct characteristics of Veradigm's various EMRs, including TouchWorks EHR, Professional EHR, and Sunrise. We leverage the Veradigm Developer Program and product-line-specific FHIR APIs and integration surfaces to ensure comprehensive data access and workflow compatibility across your Veradigm footprint.

What data does Klivira exchange between Veradigm and BCBS Arizona?

Klivira extracts relevant clinical and administrative data from your Veradigm EMR, such as patient demographics, diagnoses (Conditions), ordered services (ServiceRequest), medications (MedicationRequest), and supporting clinical documentation (DocumentReference). This data is then formatted and transmitted to BCBS Arizona via the Availity portal as part of the prior authorization request, adhering to secure data exchange protocols.

Does Klivira provide real-time prior authorization status updates?

Yes, Klivira automates the monitoring of prior authorization statuses from BCBS Arizona via the Availity portal. These updates are then surfaced within the Klivira platform and, where write-back capabilities are configured, can be reflected directly within your Veradigm EMR's task or workflow systems, providing your team with timely visibility.

Is Klivira a SMART on FHIR application for Veradigm?

Klivira leverages SMART App Launch capabilities for modern Veradigm product lines, allowing our application to be launched directly from within the EMR's clinical UI with patient context. This provides a streamlined user experience, reducing the need for manual patient lookups and improving workflow efficiency for prior authorization coordinators.

How does Klivira ensure the security of patient data during prior authorization automation?

Klivira prioritizes the security and privacy of protected health information (PHI). Our platform employs industry-standard encryption, access controls, and audit logs. All data exchanges with Veradigm EMRs and payer portals like Availity adhere to secure protocols, and our operations are designed with HIPAA and other relevant data security regulations in mind.