Veradigm (Allscripts) SCAN Health Plan Prior Authorization Automation

Achieve seamless Veradigm (Allscripts) SCAN Health Plan prior authorization automation with Klivira. Our platform integrates directly with your Veradigm EMR to streamline submissions to SCAN Health Plan, reducing manual effort and accelerating approvals.

Navigating prior authorizations for SCAN Health Plan's Medicare Advantage members from within Veradigm (Allscripts) EHRs presents unique challenges for revenue cycle teams. The manual processes of extracting clinical data, logging into payer portals, and tracking diverse authorization requirements consume significant staff time, delaying patient care and impacting financial performance. Klivira addresses these bottlenecks by automating key steps, ensuring efficient and compliant PA submissions.

The Veradigm (Allscripts) PA Challenge with SCAN Health Plan

For organizations leveraging Veradigm's diverse EMR portfolio, including TouchWorks EHR and Professional EHR, managing prior authorizations for SCAN Health Plan's Medicare Advantage members is a complex undertaking. The inherent differences in chart anatomy and workflow across Veradigm's product lines, combined with SCAN Health Plan's specific requirements for senior care services, often necessitate extensive manual effort. This swivel-chair workflow between the EMR and various payer channels delays care and diverts clinical staff from patient-facing activities.

Klivira's Integration with Veradigm (Allscripts) EHRs

Klivira integrates directly with Veradigm (Allscripts) EHRs via the Veradigm Developer Program, leveraging modern FHIR R4 APIs for secure data exchange. Our SMART App Launch integration allows prior authorization workflows to be initiated directly from within the Veradigm clinical UI, providing patient context and eliminating redundant data entry. This deep integration supports the extraction of critical clinical data, including Patient, Encounter, Coverage, and ServiceRequest resources, essential for comprehensive PA submissions.

Streamlining Prior Authorizations for SCAN Health Plan

Klivira optimizes the prior authorization process for SCAN Health Plan, a non-profit Medicare Advantage insurer focused on senior care. Our platform automates the submission of necessary clinical documentation and order details, ensuring that SCAN's specific requirements for medical necessity are met efficiently. By standardizing the data flow, Klivira helps reduce administrative burden, accelerate approval times, and improve the overall experience for providers and SCAN members.

Key Workflow Efficiencies Enabled by Klivira

Automated extraction of clinical data (e.g., Patient, Encounter, ServiceRequest) from Veradigm EHRs.
Intelligent population of SCAN Health Plan's authorization forms, reducing manual transcription errors.
Real-time status updates and notifications pushed directly to Veradigm's Tasks/Worklists.
Consolidated audit trails for all PA-related communications and decisions.
Streamlined submission of supporting clinical documentation into the Veradigm Patient Chart or Clinical Documentation sections.

Addressing Medicare Advantage PA Complexities

The unique needs of Medicare Advantage members, particularly those served by SCAN Health Plan, often involve a higher volume of complex medical and pharmacy benefit prior authorizations. Klivira's platform is designed to handle these intricacies, supporting a wide range of service lines from specialty medications and durable medical equipment to advanced imaging and surgical procedures. Our automation helps ensure that the specific clinical criteria for senior care are accurately presented to SCAN Health Plan.

Ensuring Data Integrity and Compliance

Klivira prioritizes the secure handling of protected health information (PHI) throughout the prior authorization lifecycle. Our integration with Veradigm (Allscripts) EHRs leverages industry-standard FHIR R4 APIs and SMART App Launch with robust OAuth 2.0 security protocols. This ensures that all data transmitted to SCAN Health Plan is encrypted, compliant with HIPAA regulations, and maintains the highest level of data integrity, protecting both patient privacy and organizational trust.

Frequently asked questions

How does Klivira integrate with my Veradigm (Allscripts) EHR?

Klivira integrates via the Veradigm Developer Program, utilizing FHIR R4 APIs and SMART App Launch. This allows for secure, patient-contextual workflows directly within your EMR, streamlining data exchange for prior authorizations.

Can Klivira handle PA for all Veradigm product lines, including TouchWorks EHR and Professional EHR?

Yes, Klivira supports prior authorization workflows across Veradigm's ambulatory product lines, including TouchWorks EHR and Professional EHR. While core integration principles remain consistent, specific configurations are tailored to each product line's unique technical and workflow characteristics.

Does Klivira support specific SCAN Health Plan service lines, such as specialty drugs or imaging?

Klivira's platform is highly configurable to accommodate the diverse service lines and clinical criteria required by SCAN Health Plan for its Medicare Advantage members. This includes support for specialty medications, advanced imaging, surgical procedures, and other services requiring prior authorization.

How does Klivira ensure compliance with PA regulations for Medicare Advantage?

Klivira automates the accurate capture and submission of clinical data, helping providers meet the documentation requirements for Medicare Advantage prior authorizations. We facilitate secure, auditable data exchange, supporting your organization's compliance efforts; however, final compliance responsibility rests with the provider.

Can Klivira update PA status directly in my Veradigm (Allscripts) EHR?

Yes, Klivira can leverage Veradigm's write-back capabilities to post prior authorization status updates, payer communications, and approval notifications directly into your EHR's relevant sections, such as Tasks/Worklists or Clinical Documentation, subject to EMR configuration.