Veradigm (Allscripts) Priority Health Prior Authorization Automation

Klivira delivers intelligent Veradigm (Allscripts) Priority Health prior authorization automation, directly addressing the complexities of securing approvals for Michigan-based members.

Revenue cycle directors and prior authorization coordinators face significant operational overhead navigating the varied requirements of payers like Priority Health from within Veradigm EMRs. This page outlines how Klivira's platform optimizes this critical workflow, enhancing efficiency and reducing administrative burden.

The Challenge: Prior Authorizations from Veradigm EMRs to Priority Health

Submitting prior authorizations for Priority Health members often requires navigating disparate payer portals and manual data entry, a process exacerbated when originating from diverse Veradigm (Allscripts) EMR environments such as TouchWorks EHR, Professional EHR, or Sunrise. This fragmented workflow introduces delays, increases denial rates, and diverts clinical staff from patient care, particularly for a regional insurer like Priority Health in Michigan.

Klivira's Integration with Veradigm (Allscripts) EMRs

Klivira integrates directly with Veradigm's portfolio of EMRs, leveraging the Veradigm Developer Program and FHIR R4 APIs. This enables seamless extraction of patient demographics, clinical documentation, and order details from systems like TouchWorks EHR and Professional EHR via SMART App Launch. While write-back capabilities for resources like DocumentReference and Task are more constrained, Klivira is designed to optimize the data flow for prior authorization packet assembly.

Streamlining Prior Authorizations to Priority Health

Klivira connects to Priority Health through various ePA channels and automates submissions, reducing the need for manual portal interactions. By standardizing the data extracted from Veradigm EMRs and structuring it to meet Priority Health's specific requirements, Klivira accelerates the submission process for this Michigan-based payer. This targeted approach helps minimize common errors that lead to delays or denials.

Optimizing Workflows Across Key Service Lines

For ambulatory clinics and small hospitals utilizing Veradigm EMRs, Klivira focuses on high-volume, high-cost prior authorization scenarios. This includes advanced imaging, specialty medications, and specific surgical procedures that frequently require pre-service approval from Priority Health. By automating the evidence collection and submission, Klivira ensures that the necessary clinical context is consistently provided, improving the likelihood of timely approvals.

Key Benefits of Klivira for Veradigm + Priority Health PA Automation

Automated data extraction from TouchWorks EHR, Professional EHR, and other Veradigm EMRs.
Reduced manual effort in preparing and submitting prior authorization requests to Priority Health.
Accelerated turnaround times for critical approvals, improving patient access to care.
Enhanced data accuracy and completeness in PA submissions, minimizing potential denials.
Improved staff productivity by offloading repetitive administrative tasks.
Centralized tracking and management of all Priority Health prior authorization statuses.

Frequently asked questions

How does Klivira integrate with Veradigm EMRs like TouchWorks or Professional EHR?

Klivira integrates via the Veradigm Developer Program, utilizing FHIR R4 APIs and SMART App Launch to securely extract patient and clinical data. Our integration is designed to accommodate the distinct characteristics of Veradigm's various product lines, ensuring robust data capture for prior authorization workflows.

Can Klivira handle PA submissions for all services covered by Priority Health?

Klivira is built to support a broad spectrum of prior authorization requirements for payers like Priority Health. Our platform adapts to diverse service lines, from imaging and specialty medications to surgical procedures, by structuring and submitting the necessary clinical documentation through appropriate ePA channels.

What data does Klivira pull from Veradigm for prior auth?

Klivira extracts essential data for prior authorizations, including patient demographics, encounter details, diagnoses (Conditions), orders (ServiceRequest, MedicationRequest), and supporting clinical documentation (DocumentReference). This information is gathered in compliance with US Core and FHIR standards to build a comprehensive PA packet.

How does Klivira manage updates from Priority Health on PA status?

Klivira continuously monitors payer channels for status updates from Priority Health. Our platform automates the tracking of approval, denial, or request for additional information (RFAI) notifications, ensuring your team has real-time visibility into the status of each prior authorization without manual follow-up.

How does Klivira address the different Veradigm product lines (e.g., TouchWorks, Sunrise)?

Klivira's integration strategy accounts for the operational and technical distinctions across Veradigm's product lines. We configure our platform to align with the specific integration surfaces and chart anatomies of each EMR, whether it's an ambulatory system like TouchWorks EHR or an inpatient solution like Sunrise, to ensure consistent data flow for PA.