Streamlining Veradigm (Allscripts) Fidelis Care Prior Authorization Automation

Klivira streamlines Veradigm (Allscripts) Fidelis Care prior authorization automation, integrating directly with your EMR to accelerate approvals and reduce administrative burden for your New York-based patient population.

For revenue cycle directors and prior authorization coordinators managing patient care with Fidelis Care in New York, navigating the PA process from Veradigm (Allscripts) EMRs can introduce significant workflow friction. Each manual step, from data extraction to portal submission, increases turnaround times and staff overhead, directly impacting patient access to necessary care.

Veradigm (Allscripts) EMR Integration for Enhanced PA Workflows

Klivira leverages the Veradigm Developer Program and modern FHIR R4 APIs, including US Core resources like ServiceRequest and MedicationRequest, to seamlessly integrate with Veradigm's product lines such as TouchWorks EHR and Professional EHR. Our SMART App Launch integration allows prior authorization workflows to be initiated directly from the clinician's EMR interface, pre-populating requests with patient context and clinical data. This minimizes manual data entry and ensures data accuracy from the source, directly improving efficiency for Fidelis Care submissions.

Navigating Fidelis Care Prior Authorization Requirements

Fidelis Care, a prominent Centene-owned Medicaid and Medicare plan in New York, requires specific documentation and submission protocols for prior authorizations. Klivira's platform is engineered to understand and adapt to these payer-specific requirements, whether routing through electronic prior authorization (ePA) channels, X12 278 transactions, or direct payer portal interactions. This ensures that requests for services, medications, and procedures align with Fidelis Care's guidelines, reducing common reasons for denial.

Key Prior Authorization Workflows Supported for Fidelis Care Members

Specialty medication ePA for biologics and high-cost drugs, directly from Veradigm's e-Prescribing modules.
Advanced imaging (MRI, CT) and surgical procedure authorizations, informed by Veradigm's Orders activity.
Durable Medical Equipment (DME) and home health service PAs for Fidelis Care's Medicaid population.
Behavioral health service authorizations, streamlining access to care for New York patients.
Real-time status updates and automated task management within Veradigm's Tasks/Worklists for comprehensive oversight.

Optimized Data Flow and Documentation within Veradigm EMRs

Klivira facilitates the bi-directional flow of PA-relevant data, utilizing Veradigm's FHIR write-back capabilities where available for DocumentReference and Task resources. This means submitted PA packets, payer responses, and status updates can be automatically documented within the patient's Clinical Documentation section or linked to specific Orders activity in TouchWorks EHR or Professional EHR. Our integration also supports routing follow-up tasks to Veradigm's Worklists, ensuring PA coordinators have a unified view of all pending actions without leaving their EMR.

Enhancing Patient Access and Revenue Integrity for New York Providers

For healthcare organizations serving Fidelis Care members across New York, optimizing prior authorization workflows is critical for both patient care continuity and financial health. By automating the submission process from Veradigm (Allscripts) EMRs, Klivira helps reduce administrative burdens, accelerate approval times, and minimize denials, particularly for Medicaid-focused services. This translates to improved patient access to necessary treatments and enhanced revenue cycle integrity for your practice or health system.

Frequently asked questions

How does Klivira handle different Veradigm product lines like TouchWorks and Professional EHR for Fidelis Care PAs?

Klivira is designed to integrate with the Veradigm Developer Program, providing connectivity across various product lines including TouchWorks EHR and Professional EHR. Our solution adapts to the specific integration surfaces of each Veradigm system, ensuring consistent prior authorization automation for your Fidelis Care patient population.

Can Klivira integrate with Fidelis Care's specific submission requirements for Medicaid patients in NY?

Yes, Klivira's platform is configured to address the specific prior authorization requirements of Fidelis Care, including those for Medicaid members in New York. We support various submission channels, such as ePA, X12 278, and payer portals, to ensure compliance with Fidelis Care's policies and expedite approvals.

What patient data from Veradigm is used by Klivira for prior authorization submissions?

Klivira leverages relevant clinical and administrative data from Veradigm EMRs via FHIR R4 APIs, including patient demographics, encounters, coverage information, service requests, medication requests, and supporting clinical documentation. This data is securely used to pre-populate prior authorization requests, reducing manual entry and improving accuracy.

How does Klivira provide status updates for Fidelis Care prior authorizations back into the Veradigm EMR?

Klivira facilitates the secure return of prior authorization status updates and payer communications directly into the Veradigm EMR. This typically involves documenting updates within the patient's Clinical Documentation, linking to specific Orders activity, or routing tasks to Veradigm's Worklists, providing a centralized view for PA coordinators.

Does Klivira support specialty drug prior authorizations from Veradigm for Fidelis Care members?

Yes, Klivira supports specialty drug prior authorizations, including for biologics and high-cost medications, for Fidelis Care members. Our integration with Veradigm's e-Prescribing and orders modules allows for the efficient initiation and submission of these complex requests, ensuring timely access to critical therapies.