Veradigm (Allscripts) Anthem BCBS Ohio Prior Authorization Automation

Klivira provides comprehensive Veradigm (Allscripts) Anthem BCBS Ohio prior authorization automation, streamlining the submission and tracking process directly from your EMR.

Navigating prior authorizations for Anthem BCBS Ohio from a Veradigm (Allscripts) EMR environment presents unique challenges, from disparate payer portal submissions to manual data entry. Revenue cycle directors and prior authorization coordinators face significant administrative burden and delays impacting patient care and financial performance.

The Anthem BCBS Ohio Prior Authorization Landscape

Anthem BCBS Ohio, an Elevance Health plan, primarily processes prior authorizations through the Availity portal. This channel requires meticulous data entry and often involves toggling between the EMR and the portal, increasing the risk of errors and prolonging turnaround times for critical services and medications.

Integrating Klivira with Veradigm (Allscripts) EMRs

Klivira leverages the Veradigm Developer Program, utilizing modern FHIR APIs and SMART App Launch capabilities to integrate seamlessly with your Veradigm environment. This includes core ambulatory products like TouchWorks EHR and Professional EHR, as well as the inpatient Sunrise EMR, ensuring patient context and order details flow directly into the authorization workflow.

Key Prior Authorization Workflows Automated for Veradigm & Anthem OH

**Specialty Drug ePA:** Automating submissions for high-cost medications, including biologics and GLP-1s, by extracting MedicationRequest and patient data.
**Advanced Imaging PA:** Streamlining authorizations for MRI, CT, and PET scans by leveraging ServiceRequest and clinical documentation.
**Surgical Procedure PA:** Expediting approvals for planned surgeries by compiling necessary clinical notes and orders.
**Durable Medical Equipment (DME) PA:** Facilitating authorization requests for medical devices and supplies.
**Payer Policy Integration:** Cross-referencing Anthem BCBS Ohio's specific policies and medical necessity criteria to proactively identify missing documentation.

Overcoming Veradigm Product Line Nuances for Ohio PAs

The Veradigm portfolio, encompassing TouchWorks EHR, Professional EHR, Sunrise, and Practice Fusion, presents distinct operational and technical integration considerations. Klivira's platform is designed to adapt to these variances, providing tailored connectors that respect each product line's specific chart anatomy and API surface, ensuring consistent prior authorization automation across your health system.

Streamlining Communication and Documentation within Veradigm

Klivira enhances the prior authorization process by leveraging available write-back capabilities within Veradigm EMRs. This allows for the automated deposit of PA packets via DocumentReference, updates to PA status, and creation of follow-up Tasks directly within the patient chart, reducing manual data entry and improving the audit trail for your revenue cycle and compliance teams.

Frequently asked questions

How does Klivira connect to Anthem BCBS Ohio for prior authorizations?

Klivira connects to Anthem BCBS Ohio primarily through the Availity portal, automating the submission and tracking of prior authorization requests. Our system intelligently navigates the portal, ensuring accurate data transfer and status updates without manual intervention.

Which Veradigm (Allscripts) EMR products does Klivira support for prior authorization automation?

Klivira supports the full Veradigm portfolio, including TouchWorks EHR, Professional EHR, Sunrise, and Practice Fusion. Our integration leverages the Veradigm Developer Program's FHIR APIs and, where applicable, the Veradigm Unity API, to ensure comprehensive connectivity across your ambulatory and inpatient environments.

Can Klivira handle specialty drug prior authorizations for Anthem OH?

Yes, Klivira is specifically designed to manage complex specialty drug prior authorizations for payers like Anthem BCBS Ohio. We automate the extraction of relevant MedicationRequest data from your Veradigm EMR and populate the necessary forms, supporting categories such as biologics and GLP-1s.

How does Klivira ensure patient data security with Veradigm and Anthem BCBS Ohio?

Klivira adheres strictly to HIPAA regulations and industry best practices for securing ePHI. Our integrations with Veradigm EMRs and the Availity portal utilize secure, encrypted API connections, ensuring that patient data remains protected throughout the prior authorization process. We do not store PHI beyond what is necessary for processing and audit trails.

Does Klivira support write-back of PA status into the Veradigm chart?

Yes, where supported by the specific Veradigm product line and configuration, Klivira leverages available write APIs to update the patient's chart. This includes depositing submitted PA packets as DocumentReference, updating the status of a ServiceRequest, or creating workflow Tasks for follow-up, keeping your clinical and administrative staff informed directly within their EMR.