Veradigm (Allscripts) Kaiser Permanente Prior Authorization Automation: Bridging EMR and Payer Workflows

Navigating Kaiser Permanente's Unique PA Landscape from Veradigm EMRs

Kaiser Permanente operates as an integrated payer-provider system, with most in-network prior authorizations handled within their internal Epic-based clinical workflows. For external providers—those outside the KP network or contracted for specific referrals—prior authorization submissions route through Kaiser Permanente's regional provider portals or KP Business Online. This necessitates a distinct approach for Veradigm (Allscripts) users, who must bridge their EMR data with these external KP channels.

Connecting Klivira to Your Veradigm (Allscripts) EMR Portfolio

Klivira integrates with Veradigm's diverse EMR offerings, including TouchWorks EHR, Professional EHR, Sunrise, and Practice Fusion. Leveraging the Veradigm Developer Program, we utilize modern FHIR R4 APIs and SMART App Launch capabilities to extract relevant clinical and administrative data. This ensures that patient demographics, diagnoses, orders, and clinical documentation are accurately and securely transferred for prior authorization requests, minimizing manual data entry and potential errors at the source.

Automating Prior Authorization Submissions to Kaiser Permanente

For external providers caring for Kaiser Permanente members, Klivira automates the submission process to the appropriate regional provider portals. Our platform navigates the region-specific requirements of KP Northern California, Southern California, Colorado, Georgia, Hawaii, Mid-Atlantic States, Northwest, and Washington. By ingesting region-specific utilization management criteria, Klivira helps ensure that PA requests are complete and compliant with Kaiser Permanente's medical policies, whether for commercial, Medicare Advantage, or Medicaid lines subject to CMS-0057-F.

Streamlining Workflows for Complex Procedures and Medications

The Klivira platform is designed to manage prior authorizations for high-cost medications, advanced imaging, and complex surgical procedures that often require extensive documentation. By extracting comprehensive clinical data from Veradigm EMRs via FHIR resources like ServiceRequest, MedicationRequest, and DocumentReference, Klivira builds robust PA packets. This automation reduces the administrative burden on your staff, allowing them to focus on patient care rather than manual portal navigation and data transcription for external Kaiser Permanente referrals.

Key Benefits of Klivira for Veradigm (Allscripts) and Kaiser Permanente Workflows

• Automated data extraction from Veradigm EMRs (TouchWorks, Professional EHR, Sunrise) via FHIR and SMART on FHIR.
• Targeted PA submission to Kaiser Permanente's regional provider portals for external referrals.
• Adaptation to Kaiser's region-specific utilization management policies and submission channels.
• Reduced manual effort for PA coordinators handling KP members outside the integrated network.
• Improved accuracy and completeness of PA requests for complex procedures and specialty medications.
• Support for compliance considerations related to CMS-0057-F for impacted Medicare Advantage and Medicaid lines.