athenahealth Aetna Prior Authorization Automation: Streamlining Your Workflow

Klivira delivers comprehensive athenahealth Aetna prior authorization automation, directly connecting your athenaOne workflows to Aetna's diverse submission channels. Eliminate manual data entry and accelerate approval cycles for critical services.

athenahealth users face significant administrative burdens managing prior authorizations, particularly with a large national payer like Aetna, due to constantly evolving payer rules and the necessity of navigating multiple portals. This complexity diverts staff time from patient care and impacts revenue cycle efficiency. Klivira addresses these challenges by automating the entire athenahealth Aetna prior authorization workflow.

Seamless Integration with athenahealth for Aetna PA

Klivira leverages athenahealth's robust API surface, including FHIR R4 and legacy APIs, to embed prior authorization workflows directly within athenaOne. This integration allows for automated extraction of clinical context from the Chart, Orders activity, and Documents, reducing manual data abstraction for Aetna submissions. Klivira also supports write-back capabilities for status updates and authorization numbers into athena's Inbox and Clinical Documents.

Navigating Aetna's Diverse Prior Authorization Channels

Aetna utilizes distinct channels for prior authorization based on benefit type. For medical benefits, commercial and Medicare Advantage requests primarily route through the Availity provider portal, with support for X12 278 transactions via clearinghouses. Pharmacy benefit prior authorizations are processed through CVS Caremark, leveraging ePA partners like CoverMyMeds and Surescripts, or CVS Caremark's direct portal for mail-order. Klivira intelligently routes requests to the correct Aetna channel.

Targeted Automation for Aetna Medical and Pharmacy PAs

Klivira's platform is engineered to manage the nuances of both medical and pharmacy benefit prior authorizations for Aetna members. This includes automating submissions for high-volume medical services often requiring precertification, as well as streamlining ePA workflows for prescription medications. By dynamically adapting to Aetna's Clinical Policy Bulletins (CPBs) and specific submission requirements, Klivira ensures compliance and reduces denial risks.

Key Benefits for athenahealth Practices

Reduced staff time spent on manual Aetna portal logins and data entry, freeing up PA coordinators for higher-value tasks.
Accelerated turnaround times for prior authorization decisions by eliminating submission delays and enabling proactive follow-up.
Improved revenue cycle integrity through fewer authorization-related denials and enhanced tracking of authorization statuses within athenaOne.
Consistent application of Aetna's medical necessity criteria and Clinical Policy Bulletins, leading to higher approval rates.
Direct integration into athena's Chart and Inbox, providing clinicians and staff with real-time PA status without leaving their EMR.

Staying Ahead with Aetna's Evolving PA Landscape

As Aetna navigates regulatory changes like CMS-0057-F for Medicare Advantage and Medicaid lines of business, Klivira ensures your practice remains compliant with evolving electronic prior authorization (ePA) requirements. Our platform monitors changes in Aetna's submission standards and policy updates, offering a future-proof solution that adapts to new mandates and Da Vinci PAS IG developments, where applicable to Aetna's confirmed posture.

Frequently asked questions

How does Klivira integrate with our athenahealth EMR for Aetna prior authorizations?

Klivira integrates with athenaOne via its FHIR R4 and proprietary APIs, including SMART App Launch for contextual access. This allows for automated data extraction from the patient's Chart, Orders, and Documents. Klivira also writes back authorization statuses and numbers into athena's Inbox and Documents, streamlining the PA workflow directly within your existing EMR environment.

What types of Aetna prior authorizations can Klivira automate?

Klivira automates both medical and pharmacy benefit prior authorizations for Aetna members. This includes submissions routed through Availity and X12 278 for medical services, as well as ePA through partners like CoverMyMeds and Surescripts for pharmacy benefits. Our system intelligently identifies the correct Aetna channel and submission requirements for each service or medication.

How does Klivira ensure compliance with Aetna's Clinical Policy Bulletins (CPBs)?

Klivira's platform incorporates Aetna's Clinical Policy Bulletins (CPBs) into its automation logic. By extracting relevant clinical data from athenahealth, Klivira helps ensure that submissions meet Aetna's medical necessity criteria and documentation requirements outlined in specific CPBs, thereby reducing the likelihood of denials due to non-compliance.

Does Klivira assist with Aetna prior authorization denial management?

While Klivira primarily focuses on optimizing initial prior authorization submissions to Aetna, our platform enhances denial management by providing clear audit trails and easy access to submitted documentation. This streamlines the appeal process by ensuring all necessary information is readily available, empowering your team to efficiently address Aetna's CARC and RARC denial reasons.

Is Klivira available through the athenahealth Marketplace?

Klivira is actively engaged with the athenahealth Marketplace program. Our integration is designed to meet athenahealth's standards for partner applications, ensuring a secure and efficient connection that leverages athenaOne's capabilities. For current status and availability, please contact our team.