athenahealth Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers comprehensive athenahealth Anthem (Elevance Health) prior authorization automation, directly addressing the complexities of payer-specific rules and EMR-to-payer connectivity for ambulatory practices and multi-specialty groups.

Navigating prior authorization requirements for Anthem (Elevance Health) from within athenahealth presents unique operational challenges for revenue cycle directors and prior authorization coordinators. The constant churn of payer rules, coupled with the time-consuming process of staff logging into multiple payer portals like Availity, creates significant bottlenecks. Klivira's platform is engineered to abstract this complexity, integrating seamlessly with athenahealth to automate submissions to Anthem's diverse channels.

Seamless Integration with athenahealth for Prior Authorization Workflows

Klivira integrates with athenahealth's cloud-native platform through its FHIR APIs and the athenahealth Marketplace. This deep integration allows Klivira to read critical clinical context from athenaClinicals' Chart, Orders activity, and Documents, while also leveraging SMART App Launch for contextual access. We support write-back capabilities to update athenaOne's Inbox, Tasks, and Clinical Documents with real-time prior authorization status and approved packets, minimizing manual data entry for your staff.

Comprehensive Anthem (Elevance Health) Connectivity

Anthem (Elevance Health) utilizes multiple channels for prior authorization submissions, which Klivira's platform is designed to navigate automatically. For medical benefit PAs, submissions are routed through Availity Essentials and support X12 278 transactions via clearinghouses. Pharmacy benefit PAs are managed through CarelonRx, leveraging ePA partners like CoverMyMeds and Surescripts. Klivira ensures that prior authorization requests are directed to the correct Anthem channel based on the service type and benefit.

Specialty Benefit Management for Advanced Procedures

Elevance Health's specialty benefit management vendor, Carelon Medical Benefits Management (formerly AIM Specialty Health), handles prior authorizations for advanced imaging, cardiology, musculoskeletal, sleep, and radiation oncology. Klivira's automation extends to these specialized domains, ensuring that requests for these services are routed correctly to the Carelon MBM provider portal. This eliminates the need for staff to manually identify and navigate separate portals for specific service categories.

Navigating Anthem's Utilization Management Policies

Anthem operating companies publish medical policies and clinical utilization management guidelines via provider sites accessible through Availity, with state-specific variations for commercial, Medicare Advantage, and Medicaid plans. Klivira's platform assists in streamlining adherence to these criteria by facilitating the submission of comprehensive documentation. For procedures managed by Carelon Medical Benefits Management, their specific clinical guidelines are referenced on the Carelon MBM provider site, which Klivira helps manage within the PA workflow.

Optimizing Turnaround Times and Compliance

Klivira helps accelerate prior authorization turnaround times for Anthem (Elevance Health) submissions by automating the initiation and tracking processes. For Anthem's Medicare Advantage, Medicaid managed-care, and QHP lines, the phased compliance timeline of CMS-0057-F introduces specific 72-hour standard and 24-hour expedited decision timeframes. Klivira's automation supports your organization in meeting these regulatory requirements by reducing manual delays and providing transparent status updates.

Frequently asked questions

How does Klivira integrate with athenahealth for Anthem prior authorizations?

Klivira integrates with athenahealth using FHIR APIs and is available via the athenahealth Marketplace. This allows our platform to pull necessary patient and order data from athenaClinicals, launch contextually with SMART App Launch, and write back authorization statuses and documents directly into the athenaOne chart, inbox, and tasks.

Which Anthem (Elevance Health) prior authorization channels does Klivira support?

Klivira supports all primary Anthem prior authorization channels. This includes medical benefit PAs via Availity and X12 278, pharmacy PAs through CarelonRx and ePA partners like CoverMyMeds/Surescripts, and specialty benefit PAs for services like advanced imaging, cardiology, and MSK via the Carelon Medical Benefits Management portal.

How does Klivira help with Anthem's varied utilization management policies?

Anthem's medical policies, accessed through Availity, and Carelon MBM's clinical guidelines are complex and state-specific. Klivira helps by ensuring that the correct documentation, aligned with these policies, is submitted efficiently through the appropriate channel. This reduces the likelihood of denials due to insufficient information or incorrect routing.

Can Klivira automate prior authorizations for specific service lines like advanced imaging with Anthem?

Yes, Klivira automates prior authorizations for services like advanced imaging, cardiology, and musculoskeletal procedures that are routed through Carelon Medical Benefits Management. Our platform ensures these requests are directed to the specific Carelon MBM portal and that all required clinical documentation is submitted for review.

What are the benefits of automating athenahealth Anthem PAs with Klivira?

Automating athenahealth Anthem PAs with Klivira significantly reduces the manual burden on staff, minimizes time spent on portal logins, and accelerates decision times. This leads to fewer claim denials, improved revenue cycle efficiency, and better patient access to care by streamlining a historically labor-intensive process.