Veradigm (Allscripts) Prior Authorization for Hematology: Optimizing Workflows

Navigating Hematology PA Challenges within Veradigm (Allscripts)

Hematology prior authorizations are characterized by complex clinical criteria, frequent policy updates from payers, and the need for extensive clinical documentation. For Veradigm users, integrating an efficient PA solution means leveraging the EMR's data while minimizing manual intervention for high-volume categories such as factor concentrates, sickle cell specialty drugs, and specialty imaging. Klivira's platform is designed to streamline these intricate processes.

Key Prior Authorization Categories in Hematology

• **Hemophilia Factor Concentrates:** Managing PA for factor VIII and IX products, both for prophylaxis and on-demand treatment, which are typically high-cost and require detailed utilization tracking.
• **Sickle Cell Disease Therapeutics:** Prior authorization for novel agents like voxelotor/Oxbryta and crizanlizumab/Adakveo, as well as emerging gene therapies (e.g., Casgevy, Lyfgenia).
• **Hematologic Oncology:** Covering biologics and chemotherapy for lymphomas, leukemias, and multiple myeloma, including CAR-T cell therapies (e.g., Yescarta, Kymriah) which have rigorous eligibility criteria.
• **Specialty Imaging:** PA for advanced diagnostic imaging crucial for workup and monitoring of hematologic conditions, such as MM/MGUS.
• **Bone Marrow / Stem Cell Transplant:** Complex workflows for autologous and allogeneic transplant procedures.

Klivira's Integration with Veradigm (Allscripts) EMRs

Klivira integrates directly with Veradigm's modern product lines, including TouchWorks EHR and Professional EHR, leveraging the Veradigm Developer Program and FHIR R4 APIs. This allows for the secure, standards-based exchange of critical patient data such as Patient, Encounter, Coverage, ServiceRequest, MedicationRequest, and DocumentReference resources. For hospital environments, Klivira also considers the distinct integration story of Sunrise, utilizing appropriate HL7 v2 interfaces where applicable to ensure comprehensive coverage.

Embedding PA Workflows within Veradigm's Clinical Context

Klivira utilizes SMART App Launch capabilities to embed prior authorization workflows directly within the Veradigm clinical UI. When a clinician places an order that triggers a PA, Klivira can launch with patient context from the Patient Chart or Orders activity. This allows for automated data extraction, intelligent form pre-fill, and the submission of PA requests, with status updates and payer correspondence routed back into the EMR's Tasks/Worklists and Clinical Documentation sections.

Addressing Documentation and Denial Reasons for Hematology

Hematology prior authorizations frequently face denials due to gaps in documentation against ASH guidelines and NCCN criteria, especially for novel agents or specific factor prophylaxis protocols. Klivira's platform incorporates ASH/NCCN-aware policy logic to guide documentation requirements, automate the collection of necessary clinical evidence (e.g., factor levels, prior-line therapy for CAR-T), and proactively identify potential denial reasons before submission. This minimizes rework and accelerates approval times.

Klivira's Specific Capabilities for Veradigm + Hematology

• Automated identification of PA requirements based on Veradigm order entries for hematology-specific drugs and procedures.
• Guided data capture and form completion for complex factor concentrate, sickle cell, and CAR-T therapy PAs, leveraging existing EMR data.
• Integration with Veradigm's DocumentReference write-back capabilities to deposit complete PA packets directly into the patient chart.
• Real-time status updates and communication management, routing payer responses and peer-to-peer scheduling notifications to Veradigm's task systems.
• Support for varying Veradigm product line configurations, ensuring a tailored integration experience whether on TouchWorks, Professional EHR, or Sunrise.