Streamlining Veradigm (Allscripts) TRICARE Prior Authorization Automation

Klivira offers a specialized solution for Veradigm (Allscripts) TRICARE prior authorization automation, directly addressing the complexities of military health benefit workflows.

Revenue cycle directors and prior authorization coordinators managing patient care within Veradigm's ecosystem face unique challenges when processing authorizations for TRICARE beneficiaries. Navigating regional contractors and distinct policy frameworks adds layers of manual effort and potential delays, impacting both patient access and operational efficiency.

The Veradigm-TRICARE Prior Authorization Landscape

Processing prior authorizations for TRICARE beneficiaries from a Veradigm EHR environment demands meticulous attention to regional contractor specifics and evolving medical policies. Providers must contend with separate submission channels for TRICARE East (Humana Military) and TRICARE West (TriWest), often requiring manual data entry into distinct payer portals, diverting critical staff time from patient care.

Klivira's Seamless Integration with Veradigm EHRs

Klivira integrates directly with Veradigm's portfolio, including TouchWorks EHR, Professional EHR, and Sunrise, leveraging modern integration surfaces such as FHIR R4 APIs and SMART App Launch. This connectivity allows Klivira to extract necessary clinical data (e.g., Patient, Encounter, Coverage, ServiceRequest, MedicationRequest, DocumentReference) from the Veradigm chart, minimizing manual data abstraction and ensuring data accuracy for PA submissions.

Navigating TRICARE's Regional Contractors and Policies

Klivira's platform intelligently identifies the TRICARE beneficiary's region and routes prior authorization requests through the appropriate contractor's portal—either Humana Military for TRICARE East or TriWest Healthcare Alliance for TRICARE West. We consolidate TRICARE's medical policies published on tricare.mil with the operational utilization management criteria of the regional contractors, ensuring submissions align with current requirements.

Key Benefits of Automated PA for Veradigm & TRICARE Workflows

Reduced manual data entry and administrative burden for PA coordinators.
Accelerated submission times to Humana Military and TriWest portals.
Improved accuracy of clinical data submitted, drawn directly from Veradigm EHR.
Proactive identification of PA requirements based on TRICARE policies.
Enhanced visibility into PA status updates within your existing workflows.
Optimized resource allocation, allowing staff to focus on patient care.

Optimizing PA Workflows for Military Beneficiaries

From specialty drug ePA to advanced imaging and surgical procedure authorizations, Klivira streamlines the entire prior authorization lifecycle. By integrating with Veradigm's Orders activity and leveraging data from the Patient Chart, Klivira ensures that all necessary clinical documentation is compiled and submitted efficiently to the relevant TRICARE regional contractor, supporting timely access to care for military families.

Frequently asked questions

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

Klivira integrates with Veradigm product lines (e.g., TouchWorks EHR, Professional EHR, Sunrise) via FHIR R4 APIs and SMART App Launch, leveraging the Veradigm Developer Program. This allows for secure, patient-contextual data exchange directly from your clinical workflows.

Does Klivira support both TRICARE East and TRICARE West regions?

Yes, Klivira's platform is designed to identify the beneficiary's TRICARE region and automatically route prior authorization requests to the correct regional contractor: Humana Military for TRICARE East and TriWest Healthcare Alliance for TRICARE West.

Which Veradigm product lines are compatible with Klivira's solution?

Klivira is compatible with key Veradigm product lines, including TouchWorks EHR, Professional EHR, and Sunrise. Our integration strategy is built to accommodate the distinct integration surfaces and workflows across Veradigm's ambulatory and inpatient offerings.

How does Klivira handle TRICARE's specific medical policies?

Klivira incorporates TRICARE's published medical policies from tricare.mil, layering them with the specific utilization management criteria of the regional contractors. This ensures that submitted authorizations are aligned with the most current and relevant payer requirements.

Can Klivira update PA status directly within my Veradigm EHR?

Yes, Klivira supports FHIR write-back capabilities for relevant resources such as Task and Communication, enabling the system to update prior authorization status and related workflow items directly within your Veradigm EHR, enhancing visibility and coordination.

Is Klivira part of the Veradigm Developer Program?

Klivira leverages the Veradigm Developer Program to ensure robust and compliant integration with Veradigm's EMR portfolio. This partnership facilitates secure and efficient data exchange for prior authorization automation.