Amazing Charts Aetna Prior Authorization Automation: Accelerating PA for Micro Practices

The Challenge of Aetna PA from Amazing Charts

Independent ambulatory practices, often reliant on Amazing Charts, face unique challenges when managing prior authorizations for a national insurer like Aetna. Submitting medical benefit PAs through the Availity portal or pharmacy PAs via ePA partners requires navigating multiple interfaces, duplicating data entry, and tracking disparate workflows. This fragmentation increases administrative overhead, particularly for micro practices and solo physicians focused on direct patient care.

Klivira's Integration with Amazing Charts APIs

Klivira leverages Amazing Charts APIs to establish a direct, secure connection, enabling seamless data exchange for prior authorization requests. This integration eliminates manual data transfer from the EHR to Aetna's submission channels, reducing errors and saving significant staff time. By automating the extraction of clinical data and patient demographics, Klivira ensures that your Amazing Charts records drive accurate and efficient PA submissions.

Optimizing Submissions to Aetna's Key Prior Authorization Channels

• **Medical Benefit PA:** Automating submissions to Aetna's primary medical prior authorization channel, the Availity provider portal, and supporting X12 278 transactions via clearinghouses for eligible procedure categories.
• **Pharmacy Benefit PA:** Streamlining electronic prior authorization (ePA) for outpatient retail and mail-order prescriptions through Aetna's PBM, CVS Caremark, leveraging partnerships with CoverMyMeds and Surescripts ePA.
• **Specialty Drug PA:** Managing medical-benefit specialty injectables and infused medications through dedicated specialty pharmacy management workflows, ensuring correct routing and documentation.
• **Utilization Management Policy Access:** Facilitating access to Aetna's Clinical Policy Bulletins (CPBs) to ensure submitted requests align with current medical necessity criteria, citing canonical CPB numbers and review dates.

Accelerating Aetna Medical Necessity Compliance

Aetna's medical necessity criteria, published as Clinical Policy Bulletins (CPBs), are central to successful prior authorizations. Klivira helps practices using Amazing Charts to quickly reference and apply relevant CPB requirements. This ensures that submitted documentation precisely addresses Aetna's guidelines, reducing the likelihood of denials due to insufficient medical necessity evidence or missing step therapy attestations.

Key Aetna PA Workflows for Amazing Charts Users

For Amazing Charts users, common Aetna PA scenarios include advanced imaging, surgical procedures, and specialty medications managed under the medical benefit. Klivira centralizes these diverse workflows, providing a unified platform to manage requests, track statuses, and receive updates directly within your integrated environment, minimizing the need to log into multiple payer portals.

Meeting Turnaround Times and Compliance Standards

Aetna's prior authorization turnaround times are influenced by state regulations, NCQA Utilization Management accreditation standards, and for Medicare Advantage plans, CMS-0057-F requirements. Klivira's automation capabilities help Amazing Charts practices meet these varied deadlines by accelerating submission and follow-up processes, supporting timely care delivery and reducing administrative burden associated with compliance.