Streamlining Veradigm (Allscripts) Cigna Prior Authorization Automation

Klivira delivers Veradigm (Allscripts) Cigna prior authorization automation, integrating directly with your EMR to connect seamlessly with Cigna Healthcare and Evernorth channels.

Managing prior authorizations between Veradigm (Allscripts) EMR environments and Cigna Healthcare's diverse channels presents significant operational overhead. Revenue cycle directors and prior authorization coordinators face challenges navigating distinct submission pathways for medical, pharmacy, and specialty benefits, often leading to manual effort and delays. Klivira provides a unified solution to streamline these complex workflows.

Connecting Klivira with Veradigm (Allscripts) EMRs

Our platform integrates with the full Veradigm portfolio, including TouchWorks EHR, Professional EHR, and Sunrise, via the Veradigm Developer Program. Leveraging FHIR API capabilities, Klivira accesses patient context (Patient, Encounter, Coverage, ServiceRequest, MedicationRequest) and clinician orders directly from your EMR. This integration supports SMART App Launch for a seamless user experience within the clinical UI, ensuring that PA workflows are initiated with complete patient data.

Cigna Healthcare Prior Authorization Submission Channels

**Medical Benefit PA:** Submissions to Cigna Healthcare are automated via CignaforHCP.com, the primary provider portal, and through X12 278 transactions for eligible procedures.
**Pharmacy Benefit PA:** For pharmacy services, Klivira connects with Express Scripts, operating under the Evernorth brand. This includes electronic PA (ePA) routing through established partners like CoverMyMeds and Surescripts.
**Specialty Drug PA:** Specialty medications, whether under medical or pharmacy benefit, are managed through appropriate Cigna Healthcare channels or Accredo, the specialty pharmacy within Evernorth.
**Utilization Management Policies:** Klivira references Cigna's published coverage policies and medical-necessity guidelines available through their public provider site, ensuring submissions align with current criteria.

Automating Key Prior Authorization Workflows

Klivira automates the end-to-end prior authorization lifecycle, from initial submission to status tracking and appeal management. This includes medical procedures requiring precertification, retail and specialty pharmacy prescriptions, and advanced imaging services. By integrating directly with Veradigm's order activity and task systems, Klivira ensures that prior authorization requests are triggered accurately and associated documentation is submitted efficiently, reducing manual data entry and improving turnaround times.

Compliance and Interoperability Considerations

For Cigna's Medicare Advantage and Qualified Health Plan lines, Klivira's automation capabilities align with the phased compliance requirements of CMS-0057-F, addressing federal mandates for faster PA decisions. Klivira also supports the HL7 Da Vinci Project's interoperability standards, facilitating the exchange of PA data. We encourage discussions with your compliance team to ensure full alignment with regulatory requirements and internal policies regarding ePHI exchange and data security.

Operational Impact for Veradigm (Allscripts) Users

By automating Cigna prior authorizations, your organization can expect a reduction in administrative burden, improved staff productivity, and a decrease in authorization-related denials. Klivira's write-back capabilities ensure that PA status updates, payer correspondence, and approved authorization numbers are recorded directly within the Veradigm patient chart, providing a consolidated view for clinicians and administrative staff. This integration frees up prior authorization coordinators to focus on complex cases and patient care.

Frequently asked questions

How does Klivira integrate with Veradigm's different EMR products for Cigna PA?

Klivira integrates with Veradigm's various EMRs, including TouchWorks EHR, Professional EHR, and Sunrise, primarily through the Veradigm Developer Program and its FHIR API. This allows us to access clinical data and leverage SMART App Launch for a seamless workflow directly within your EMR's clinical UI, initiating Cigna PA requests with complete patient context.

Which Cigna PA channels does Klivira automate?

Klivira automates submissions across Cigna Healthcare's key channels. For medical benefits, we connect with CignaforHCP.com and support X12 278 transactions. For pharmacy benefits, we integrate with Express Scripts (Evernorth) and their ePA partners like CoverMyMeds and Surescripts, including specialty drug pathways via Accredo.

Can Klivira help with Cigna's specific medical necessity guidelines?

Yes, Klivira's system is designed to reference Cigna Healthcare's published coverage policies and medical-necessity guidelines. By ensuring that submitted documentation aligns with these criteria, Klivira helps optimize the PA submission process and reduces the likelihood of denials due to insufficient clinical information.

How does Klivira ensure compliance with regulations like CMS-0057-F for Cigna PAs?

Klivira's automation capabilities are built to support compliance with regulations such as CMS-0057-F, which mandates expedited PA timeframes for Medicare Advantage and QHP lines. Our platform helps streamline the submission and tracking process to meet these requirements, though specific compliance strategies should always be discussed with your internal compliance team.

Does Klivira write PA status updates back into the Veradigm EMR?

Yes, Klivira supports write-back capabilities for PA-relevant information into your Veradigm EMR. This includes updating authorization statuses, depositing payer correspondence, and recording approved authorization numbers directly within the patient chart, providing a comprehensive and up-to-date record for your clinical and administrative staff.