CompuGroup (Aprima) eviCore Integration for Automated Prior Authorizations

Seamless eviCore Prior Authorization Workflow within CompuGroup (Aprima)

Klivira's integration with CompuGroup (Aprima) transforms the eviCore prior authorization process. When a provider places an order for an eviCore-managed service within Aprima’s Order Entry module, Klivira intelligently intercepts the request. Our platform automatically initiates the ePA process, leveraging clinical data already documented in the patient's chart to build a comprehensive authorization submission, eliminating the need for manual form completion or external portal navigation.

Key Data Exchange Points for CompuGroup (Aprima) eviCore Integration

• **From Aprima (via CGM APIs):** Patient demographics, insurance information, ordering provider details, CPT/HCPCS codes, ICD-10 diagnoses, clinical notes, and relevant medical history documented in the Patient Chart.
• **To Klivira (for eviCore submission):** Structured clinical data, supporting documentation, and the X12 278 request for authorization.
• **From eviCore (via Klivira):** Authorization status updates, authorization numbers, denial reasons, and specific requests for additional clinical information (RFI).
• **To Aprima (via CGM APIs):** Real-time status updates, authorization numbers, and communication logs are pushed back into the relevant patient records or task management queues within Aprima.

Leveraging CGM APIs for Efficient Data Flow

The foundation of our CompuGroup (Aprima) eviCore integration relies on robust connectivity through CGM APIs. This programmatic interface ensures secure, bi-directional data exchange, allowing Klivira to extract necessary clinical and administrative data directly from Aprima. This approach minimizes disruption to existing clinical workflows and ensures that critical information, such as ordered procedures and diagnoses, is accurately and consistently used for prior authorization submissions, maintaining data integrity and reducing errors.

Optimizing Prior Authorization Coordination for Aprima Users

For prior authorization coordinators, the Klivira integration means less time spent on administrative tasks and more focus on complex cases. The system automates routine eviCore submissions, tracks statuses, and alerts staff to pending actions or denial notifications directly within their Aprima workflow environment. This proactive management capability is crucial for services like radiology, cardiology, and oncology, where timely authorization directly impacts patient care and revenue cycles.

Ensuring Data Security and Compliance

All data exchanged between CompuGroup (Aprima), Klivira, and eviCore is handled with stringent security protocols, adhering to HIPAA guidelines for PHI and ePHI. Our platform is designed to maintain data integrity and confidentiality throughout the prior authorization lifecycle, providing peace of mind for IT integration leads and compliance teams. We ensure that only necessary and authorized data is transmitted for each prior authorization request.