Amazing Charts Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers Amazing Charts Anthem (Elevance Health) prior authorization automation, significantly reducing the administrative burden for micro practices and solo physicians.

Navigating prior authorizations with Anthem, an Elevance Health company, can be complex, especially for practices utilizing Amazing Charts. The challenge is compounded by multiple submission channels and diverse policy requirements. Klivira streamlines this process, enabling your team to focus on patient care rather than manual paperwork.

The Challenge of Anthem Prior Authorizations for Amazing Charts Users

Amazing Charts users, often operating in micro practices, face a unique challenge with Anthem's multi-faceted prior authorization landscape. Submissions for medical benefits typically route through Availity Essentials, while pharmacy PAs are managed by CarelonRx via partners like CoverMyMeds and Surescripts. Furthermore, specialty benefit management for areas like advanced imaging or cardiology is directed through Carelon Medical Benefits Management's distinct portal. This fragmentation demands significant manual effort and deep operational knowledge from staff.

Klivira's Integration with Amazing Charts

Klivira integrates directly with Amazing Charts via its available APIs. This connection allows for the seamless extraction of necessary patient demographics, clinical notes, and order details directly from the AC EHR. By automating data transfer, Klivira eliminates redundant data entry, reduces transcription errors, and accelerates the initiation of prior authorization requests for Anthem-covered services.

Navigating Anthem's Diverse Prior Authorization Channels

Anthem-licensed plans utilize several distinct channels for prior authorization, each with specific requirements: medical benefit PAs are primarily via Availity, with X12 278 transactions also supported. Pharmacy benefit PAs, managed by CarelonRx, leverage ePA platforms. Specialized services like advanced imaging, cardiology, or musculoskeletal procedures route through the Carelon Medical Benefits Management portal. Klivira's platform intelligently directs each request to the correct Anthem channel, ensuring compliance with payer-specific submission rules.

Streamlining Policy Access and Turnaround Times

Anthem operating companies publish medical policies and clinical utilization management guidelines through provider sites accessible via Availity. For domains managed by Carelon Medical Benefits Management, their specific clinical guidelines are found on the Carelon MBM provider site. Klivira centralizes this intelligence, helping practices align submissions with the correct criteria. For Medicare Advantage, Medicaid, CHIP, and QHP-on-FFM lines, Anthem plans are impacted by CMS-0057-F, which mandates specific decision timeframes.

Automating Complex Workflows: Specialty Drugs and Imaging

For Amazing Charts users, managing prior authorizations for specialty injectables, infusions, and advanced imaging can be particularly time-consuming. These often involve specific site-of-care policies or route through Carelon Medical Benefits Management. Klivira automates the extraction of relevant clinical documentation from Amazing Charts, pre-populates forms, and tracks submissions through the appropriate Anthem (or Carelon) portal, ensuring that complex requests for biologics, GLP-1s, or MRI scans are processed efficiently.

Frequently asked questions

How does Klivira automate prior authorizations for Anthem (Elevance Health) through Amazing Charts?

Klivira integrates with Amazing Charts via its APIs to extract patient and clinical data. This data is then used to intelligently populate and submit prior authorization requests to the appropriate Anthem channel, whether it's Availity for medical PAs, CarelonRx's ePA partners for pharmacy, or the Carelon Medical Benefits Management portal for specialty benefits.

Can Klivira handle Anthem's multiple prior authorization portals for Amazing Charts users?

Yes, Klivira is designed to navigate Anthem's complex ecosystem. It directs medical benefit PAs to Availity, pharmacy PAs to ePA partners like CoverMyMeds or Surescripts, and specialty benefit PAs (e.g., for imaging, cardiology, MSK) to the Carelon Medical Benefits Management portal, all while maintaining a consistent workflow for your Amazing Charts users.

Does Klivira help Amazing Charts practices comply with Anthem's medical policies and CMS regulations?

Klivira streamlines access to Anthem's medical policies and Carelon MBM's clinical guidelines, aiding in the submission of compliant requests. For Anthem's Medicare Advantage and Medicaid plans, Klivira's automation supports adherence to the specific decision timeframes mandated by CMS-0057-F.

What types of prior authorizations can Klivira automate for Amazing Charts and Anthem?

Klivira can automate a wide range of prior authorizations, including those for medical procedures, specialty drugs (both medical and pharmacy benefit), advanced imaging, cardiology, musculoskeletal services, and other services managed by Anthem's various channels. This includes submissions via Availity, X12 278, and the Carelon Medical Benefits Management portal.

How does Klivira improve turnaround times for Amazing Charts users submitting to Anthem?

By automating data extraction, form population, and submission tracking, Klivira significantly reduces the manual steps involved in prior authorization. This efficiency helps Amazing Charts users meet payer-published service-level targets and state-mandated minimums, including the expedited timeframes for plans impacted by CMS-0057-F.