Veradigm (Allscripts) Clover Health Prior Authorization Automation

Klivira delivers robust Veradigm (Allscripts) Clover Health prior authorization automation, streamlining the complex process for Medicare Advantage plans.

Revenue cycle directors and prior authorization coordinators face significant challenges managing prior authorizations, especially when navigating the distinct requirements of Medicare Advantage plans like Clover Health from within various Veradigm (Allscripts) EMR environments. Manual processes lead to delays, denials, and administrative burden, impacting patient care and financial health.

The Challenge: Veradigm (Allscripts) EMRs and Clover Health PAs

Organizations utilizing Veradigm's diverse EMR portfolio—including TouchWorks EHR, Professional EHR, and Sunrise—often encounter friction when submitting prior authorizations to Clover Health. Each EMR product line has unique workflow characteristics, further complicated by Clover Health's specific requirements for its Medicare Advantage members. This necessitates a solution that understands both the EMR's data structure and the payer's submission nuances.

Klivira's Integration with Veradigm (Allscripts) EMRs

Klivira integrates directly with Veradigm's modern EMR platforms via the Veradigm Developer Program, leveraging FHIR R4 APIs and SMART App Launch capabilities. This allows for seamless, secure data exchange, pulling essential patient, encounter, and order details from systems like TouchWorks EHR or Professional EHR. Our integration supports critical FHIR resources such as Patient, Encounter, Coverage, ServiceRequest, MedicationRequest, DocumentReference, Practitioner, Condition, and Observation data, ensuring comprehensive data extraction.

Streamlining Submissions to Clover Health Medicare Advantage

For Clover Health Medicare Advantage plans, Klivira centralizes the prior authorization submission process. Our platform is engineered to manage the diverse channels required by payers, ensuring that requests align with Clover Health's specific requirements. By automating the compilation of clinical documentation and submission, Klivira helps reduce manual data entry across disparate systems, accelerating the path to approval for critical services.

Key Benefits of Klivira for Veradigm (Allscripts) & Clover Health

Automated data extraction from Veradigm's TouchWorks EHR and Professional EHR via FHIR APIs.
Standardized submission pathways for Clover Health Medicare Advantage requests.
Real-time status updates and task management integrated within EMR worklists.
Reduced manual data entry and administrative overhead for PA coordinators.
Improved turnaround times for critical patient services requiring prior authorization.
Enhanced compliance considerations through structured data and audit trails.

Secure Data Exchange and Write-back Capabilities

Klivira ensures secure, HIPAA-compliant exchange of PHI. We leverage Veradigm's FHIR APIs for robust data retrieval and support write-back capabilities for PA artifacts directly into the EMR. This includes depositing DocumentReference for packet uploads and updating Task resources for workflow management, optimizing the clinician's and coordinator's view of prior authorization status within their native Veradigm environment.

Frequently asked questions

How does Klivira integrate with my specific Veradigm EMR product line (e.g., TouchWorks, Professional EHR, Sunrise)?

Klivira leverages the Veradigm Developer Program, utilizing FHIR R4 APIs and SMART App Launch for modern ambulatory platforms like TouchWorks EHR and Professional EHR. For Sunrise or legacy systems, we assess specific integration points including HL7 v2 and the Veradigm Unity API to ensure comprehensive coverage tailored to your deployment.

Can Klivira handle prior authorizations for all types of services covered by Clover Health Medicare Advantage plans?

Yes, Klivira is designed to support a broad spectrum of services requiring prior authorization under Medicare Advantage plans, including those offered by Clover Health. This encompasses medical procedures, imaging, durable medical equipment, and specialty medications, by efficiently gathering the necessary clinical evidence from your EMR.

What specific data does Klivira extract from Veradigm (Allscripts) for prior authorization submissions?

Klivira extracts relevant clinical and administrative data using Veradigm's FHIR APIs, including Patient demographics, Encounter details, Coverage information, ServiceRequest, MedicationRequest, DocumentReference, Practitioner, Condition, and Observation data. This ensures a comprehensive and accurate submission packet to Clover Health.

How does Klivira help reduce denials for Clover Health Medicare Advantage submissions?

By automating data collection and ensuring all required clinical documentation is accurately included in the submission, Klivira helps reduce incomplete or inaccurate requests. This proactive approach minimizes common reasons for denials from payers like Clover Health, improving the likelihood of first-pass approvals and reducing rework.

Does Klivira provide real-time status updates for Clover Health prior authorizations?

Klivira integrates with your Veradigm EMR's task and worklist systems to provide timely updates on prior authorization statuses. While real-time payer status availability varies by payer and channel, our system centralizes communication and tracks progress, reducing the need for manual follow-up and improving workflow visibility.