Streamlining Veradigm (Allscripts) Molina Healthcare Prior Authorization Automation

Navigating Molina Healthcare PAs from Veradigm EMRs

Molina Healthcare's diverse coverage, including Medicaid managed care and ACA marketplace plans, requires providers to manage state-specific policies and submission channels. For medical benefit prior authorizations, Molina frequently routes submissions through the Availity portal. Pharmacy benefit prior authorizations often leverage ePA partners like CoverMyMeds and Surescripts. Klivira's platform understands these varied requirements, ensuring that PA requests originating from your Veradigm EMR are directed through the correct channels to Molina Healthcare.

Seamless Integration with Veradigm (Allscripts) Portfolio

Klivira integrates with Veradigm's comprehensive EMR portfolio, including TouchWorks EHR, Professional EHR, and Sunrise, via the Veradigm Developer Program. Leveraging FHIR R4 APIs for US Core resources and and SMART App Launch, Klivira can access critical patient, encounter, and order data directly from your Veradigm system. This deep integration allows for the automated assembly of PA packets, reducing manual data entry and ensuring clinical documentation is accurately linked to the prior authorization request.

Automating Prior Authorization Workflows for Molina Members

Our solution streamlines prior authorization workflows for Molina Healthcare members across various service lines. Whether it's medical benefit PAs for imaging, surgical procedures, or specialty medications, Klivira automates the submission process. By integrating with Veradigm's 'Orders activity / e-Prescribing' and 'Tasks / Worklists' sections, Klivira ensures that prior authorization triggers are captured early, and status updates, payer correspondence, and peer-to-peer scheduling are routed efficiently within the clinical workflow.

Key Benefits of Klivira for Veradigm & Molina Healthcare PA

• Automated data extraction from Veradigm's Patient Chart and Clinical Documentation for PA packet assembly.
• Direct submission of medical benefit PAs to Molina via Availity and other designated channels.
• Integration with ePA partners like CoverMyMeds and Surescripts for pharmacy benefit prior authorizations.
• Real-time status tracking and write-back of PA decisions into relevant Veradigm chart sections.
• Adherence to CMS-0057-F and state Medicaid managed care turnaround time mandates.
• Reduced administrative burden for prior authorization coordinators and clinical staff.

Compliance with Regulatory Mandates for Molina Healthcare

Molina Healthcare's lines of business, including Medicaid managed care, D-SNP MA, CHIP, and QHP-on-FFM, are all impacted payers under CMS-0057-F. This regulation mandates specific decision-timeframes and data exchange requirements. Klivira’s platform is engineered to apply the correct decision-timeframe expectations for each Molina line of business and supports the necessary data exchange, helping your organization maintain compliance and avoid potential penalties. Discuss specific compliance considerations with your internal team.

Enhancing Data Exchange and Write-Back Capabilities

Beyond submission, Klivira focuses on comprehensive data exchange. We leverage Veradigm's integration surfaces to push prior authorization status updates, payer communication, and final decisions back into the EMR. This write-back capability, often to DocumentReference for packet upload or Task for workflow updates, ensures that the Veradigm Patient Chart remains the single source of truth for all prior authorization activities, providing clinicians and revenue cycle teams with immediate visibility into approval statuses.