Veradigm (Allscripts) VA Community Care Prior Authorization Automation

The Challenge: Manual Prior Authorizations in Veradigm for VA Community Care

Healthcare organizations utilizing Veradigm's EMRs—including TouchWorks EHR, Professional EHR, and Sunrise—face significant overhead when managing prior authorizations for patients covered by VA Community Care. The VA Community Care Network (VA CCN) operates through regional contractors like Optum (East) and TriWest (West), each potentially with distinct submission requirements. This landscape often necessitates manual portal submissions, phone calls, and faxes, diverting staff time from direct patient care and delaying access to vital services for veterans.

Streamlining Veradigm (Allscripts) Prior Authorization Workflows

Klivira integrates directly with Veradigm's EMR portfolio, leveraging the Veradigm Developer Program and FHIR R4 APIs to embed prior authorization automation within your existing clinical environment. Our platform accesses critical patient data—such as Patient, Encounter, Coverage, and ServiceRequest resources—from your TouchWorks EHR, Professional EHR, or Sunrise system. This direct integration minimizes context switching for your prior authorization coordinators and enables a more efficient, data-driven workflow for all VA Community Care submissions.

Navigating VA Community Care Network Connectivity

Klivira's platform is engineered to connect with the diverse channels required by VA Community Care contractors. Whether it's submitting to Optum (East) or TriWest (West), our system intelligently routes and manages prior authorization requests. We translate the clinical data from your Veradigm EMR into the appropriate formats required by each VA CCN contractor, ensuring compliance with their specific guidelines and accelerating the approval process for a wide range of services, from specialty consultations to diagnostic imaging.

Key Prior Authorization Workflows for Veradigm + VA Community Care

Our automation addresses high-volume and high-cost prior authorization categories critical for veteran care. This includes specialty care referrals, advanced imaging (e.g., MRI, CT scans), surgical procedures, and certain durable medical equipment. By automating the extraction of necessary clinical documentation from your Veradigm EMR's Clinical Documentation and Orders activity, Klivira helps ensure that comprehensive, payer-specific packets are assembled and submitted accurately to VA Community Care contractors.

Benefits of Klivira's Veradigm (Allscripts) VA Community Care Automation

• Reduce manual data entry and administrative burden for prior authorization coordinators.
• Accelerate prior authorization submission and response times for VA Community Care.
• Enhance data accuracy by directly pulling clinical information from your Veradigm EHR.
• Improve patient satisfaction by expediting access to approved veteran care services.
• Gain visibility into prior authorization status for requests submitted to Optum and TriWest.
• Streamline documentation write-back into the Veradigm patient chart.

Klivira's Integration Approach with Veradigm EMRs

Klivira integrates as a SMART App Launch application, enabling seamless access from within the Veradigm clinical UI. This provides patient context directly to our platform, initiating prior authorization workflows efficiently. We leverage Veradigm's FHIR R4 APIs for robust data exchange, including read access to US Core resources and targeted write-back capabilities for PA status updates, payer correspondence, and documentation directly into the Patient Chart or Tasks/Worklists within TouchWorks EHR, Professional EHR, or Sunrise. Our approach accounts for the distinct integration surfaces and capabilities across Veradigm's diverse product lines.