Streamlining Veradigm (Allscripts) Centene Prior Authorization Automation

Klivira delivers robust Veradigm (Allscripts) Centene prior authorization automation, bridging the gap between your clinical workflows and Centene's complex payer ecosystem.

Revenue cycle leaders and prior authorization coordinators face significant operational challenges when managing prior authorizations for Centene's diverse portfolio of plans from within the Veradigm (Allscripts) EMR environment. The federated nature of Centene's subsidiaries, coupled with varying state and federal requirements, demands a precise and automated approach to PA submission and tracking.

Navigating Centene's Federated Payer Landscape from Veradigm

Centene Corporation operates through numerous state-licensed subsidiaries like Ambetter, WellCare, and various Medicaid managed care plans, each with its own provider portals and specific prior authorization rules. Submitting PAs for services ordered within Veradigm's TouchWorks EHR, Professional EHR, or Sunrise EMRs requires a nuanced understanding of these distinct channels to ensure compliance and timely processing.

Klivira's Integration with Veradigm (Allscripts) EMRs

Klivira integrates directly with Veradigm's EMR platforms through the Veradigm Developer Program, leveraging FHIR API capabilities. This allows for seamless extraction of patient, encounter, and service request data from your Veradigm system, including TouchWorks EHR, Professional EHR, and Sunrise, minimizing manual data entry and ensuring clinical context is maintained for prior authorization submissions.

Optimizing Centene Prior Authorization Submission Channels

Klivira automates PA submissions across Centene's varied channels. This includes routing medical PAs via X12 278 transactions where supported, and through subsidiary-specific provider portals. For pharmacy benefits, Klivira connects with Envolve Pharmacy Solutions and ePA partners like CoverMyMeds and Surescripts, ensuring comprehensive coverage for retail and specialty drug authorizations.

Addressing Diverse Centene Policy and Workflow Requirements

Centene's utilization management policies vary significantly by subsidiary, line of business (Medicaid managed care, ACA marketplace, Medicare Advantage), and state mandates. Klivira streamlines workflows for complex services such as imaging, surgical procedures, and specialty medications, adapting to the specific clinical criteria and policy libraries published by each Centene subsidiary. This includes adherence to state Medicaid agency rules for Medicaid lines and CMS-mandated timeframes for Wellcare and Allwell Medicare plans.

Preparing for CMS-0057-F Compliance Across Centene Plans

Centene's broad scope as an impacted payer under CMS-0057-F, encompassing its Medicaid managed care, Medicare Advantage, and ACA marketplace lines, necessitates robust electronic prior authorization capabilities. Klivira helps Veradigm users meet the evolving requirements for faster PA decisions and enhanced transparency, positioning your organization for future compliance with federal mandates.

Key Benefits for Veradigm Users with Centene Plans

Automated data extraction from Veradigm (Allscripts) EMRs via FHIR APIs.
Streamlined submission to Centene's diverse subsidiary portals and X12 278 channels.
Real-time status tracking and communication updates within your existing workflow.
Reduced manual effort and administrative burden for PA coordinators.
Improved turnaround times and lower denial rates for Centene authorizations.
Support for pharmacy (NCPDP SCRIPT) and medical (X12 278) PA workflows.

Frequently asked questions

How does Klivira integrate with my Veradigm (Allscripts) EMR for Centene PAs?

Klivira integrates with Veradigm EMRs, including TouchWorks EHR, Professional EHR, and Sunrise, using the Veradigm Developer Program and FHIR APIs. This allows for secure, bi-directional data exchange, pulling necessary clinical information for PA requests and pushing status updates back into your patient chart or task lists.

Can Klivira handle Centene's different plan types like Ambetter, Wellcare, and Medicaid managed care?

Yes, Klivira is designed to manage the complexities of Centene's federated structure. We support PA submissions for Ambetter (ACA marketplace), Wellcare/Allwell (Medicare Advantage), and Centene's various state-specific Medicaid managed care plans, adapting to the unique policy requirements and submission channels of each.

Does Klivira support both medical and pharmacy prior authorizations for Centene?

Absolutely. Klivira provides comprehensive support for both medical and pharmacy prior authorizations with Centene. For pharmacy benefits, we connect with Envolve Pharmacy Solutions and ePA platforms like CoverMyMeds and Surescripts. For medical services, submissions are routed via X12 278 or directly to the relevant Centene subsidiary's provider portal.

How does Klivira address the varying Centene medical policies and state mandates?

Klivira's platform is built to navigate the diverse utilization management policies published by each Centene subsidiary. We ingest and apply relevant criteria, considering state Medicaid agency rules for Medicaid plans and CMS-mandated timeframes for Medicare Advantage, ensuring submissions align with the correct guidelines.

What is Klivira's role in helping us comply with CMS-0057-F for Centene authorizations?

Klivira facilitates compliance with CMS-0057-F by enabling electronic prior authorization and supporting the requirements for faster decision-making and transparency. Given Centene's status as an impacted payer across its government-program lines, Klivira helps your organization prepare for and meet these evolving federal mandates by streamlining your PA processes.