Automating Veradigm (Allscripts) Epidural Steroid Injection Prior Authorization

Klivira streamlines the complex process of Veradigm (Allscripts) Epidural Steroid Injection prior authorization, integrating directly with your EMR to automate data extraction and submission.

For revenue cycle directors and prior authorization coordinators managing pain management services, the manual burden of securing prior authorizations for procedures like Epidural Steroid Injections (ESI) within the Veradigm (Allscripts) ecosystem can significantly impact operational efficiency and patient access. Klivira provides a robust solution designed to navigate the distinct integration surfaces and data structures across Veradigm's diverse product lines, from TouchWorks EHR to Sunrise.

Navigating Epidural Steroid Injection Orders in Veradigm

Ordering an Epidural Steroid Injection (ESI) in Veradigm's ambulatory products like TouchWorks EHR or Professional EHR typically initiates within the 'Orders activity' section. For inpatient settings using Sunrise, orders are placed via the standard clinician ordering modules. These orders, categorized under pain management, often trigger a prior authorization requirement due to payer medical policies that mandate a conservative care trial, imaging confirmation of pathology, and sometimes a history of prior injections. Klivira intercepts these orders to initiate the automated PA workflow.

Leveraging Veradigm's Clinical Documentation for ESI PA

Prior authorization for Epidural Steroid Injections critically depends on comprehensive clinical documentation. Across Veradigm's product lines, Klivira accesses relevant data from the 'Patient Chart' and 'Clinical Documentation / Notes'. This includes patient demographics, encounter history, diagnoses (Condition), imaging results (DocumentReference, Observation), conservative treatment trials, and details of prior injections. Klivira utilizes FHIR R4 APIs and the Veradigm Unity API to programmatically extract these necessary data points, ensuring all payer requirements are met for a complete submission.

Klivira's Integration with Veradigm's Diverse EMR Portfolio

The Veradigm portfolio, encompassing TouchWorks EHR, Professional EHR, Sunrise, and Practice Fusion, presents varied integration surfaces. Klivira leverages the Veradigm Developer Program, utilizing FHIR R4 read APIs for US Core resources (Patient, ServiceRequest, DocumentReference) and SMART App Launch for contextual workflows within the clinical UI. For legacy deployments or specific data requirements, Klivira also integrates via the Veradigm Unity API and HL7 v2 interfaces, ensuring comprehensive connectivity regardless of your specific Veradigm product line.

Automating ESI PA Submission via Payer Channels

Once clinical data for an Epidural Steroid Injection is compiled from your Veradigm EMR, Klivira automates the submission through the appropriate payer channels. This includes electronic prior authorization (ePA) via X12 278 transactions, direct portal submissions, or secure fax, based on payer capabilities and policy. Klivira's system tracks the PA status, routing updates and payer correspondence directly to the 'Tasks / Worklists' within your Veradigm EMR, minimizing manual follow-up and improving turnaround times.

Considerations for Veradigm Write-Back Capabilities

While Veradigm's read APIs are robust, write-back capabilities for PA-relevant resources like DocumentReference for packet upload or Task for workflow updates are more limited and vary by product line and customer configuration. Klivira designs its integration to accommodate these distinctions, ensuring that PA status, payer communications, and approval documents are accurately reflected in the patient chart, often by depositing artifacts into 'Clinical Documentation / Notes' or updating 'Tasks / Worklists' where write access is confirmed.

Frequently asked questions

How does Klivira handle the different Veradigm EMR products for ESI PA?

Klivira's integration is designed to account for the distinct operational and technical characteristics of Veradigm's product lines, including TouchWorks EHR, Professional EHR, Sunrise, and Practice Fusion. We utilize specific connectors and API pathways (FHIR, Veradigm Unity API, HL7 v2) tailored to each product's capabilities, ensuring consistent and accurate data extraction for Epidural Steroid Injection prior authorizations.

What ESI-specific clinical data does Klivira extract from Veradigm?

For Epidural Steroid Injection prior authorizations, Klivira extracts crucial clinical data from your Veradigm EMR. This includes patient demographics, relevant diagnoses (Condition), documentation of conservative care trials, details from imaging studies (DocumentReference, Observation), and records of any prior injections, all of which are commonly required by payers for ESI PA approval.

Can Klivira integrate with my Veradigm EMR if it's self-hosted?

Yes, Klivira's integration approach is flexible. For self-hosted Veradigm deployments, we work with your IT team to establish secure connectivity, leveraging the Veradigm Developer Program's FHIR APIs or the Veradigm Unity API. OAuth 2.0 token endpoints are discovered via the SMART well-known configuration at your customer's FHIR base URL for secure data exchange.

How does Klivira ensure ESI PA status updates are visible in Veradigm?

Klivira ensures that Epidural Steroid Injection prior authorization status updates are routed back into your Veradigm EMR. This typically involves updating 'Tasks / Worklists' for PA coordinators or depositing payer correspondence and approval documents into the 'Clinical Documentation / Notes' section of the patient chart, depending on confirmed write-back capabilities and your specific EMR configuration.