Elevating athenahealth Clover Health Prior Authorization Automation

Navigating Clover Health Prior Authorizations from athenaOne

Ambulatory practices and physician groups using athenahealth frequently encounter unique challenges when submitting prior authorizations to Clover Health. As a Medicare Advantage plan, Clover Health's specific medical policies and utilization management criteria necessitate precise documentation and adherence to evolving guidelines. The manual process of extracting clinical data from athenaOne and re-entering it into various payer channels for Clover Health consumes valuable staff time and introduces potential for errors.

Klivira's Deep Integration with athenahealth for PA Automation

Klivira integrates directly with athenahealth's cloud-native platform, leveraging its advanced API surfaces to embed prior authorization automation into existing clinical and administrative workflows. Utilizing FHIR R4 read APIs, Klivira accesses essential patient, encounter, coverage, and service request data from athenaClinicals. This robust integration minimizes manual data entry and ensures that the prior authorization process is initiated with accurate, real-time patient context directly from athenaOne.

Core Integration Points within athenaOne

• **FHIR API Connectivity:** Accessing clinical context (Patient, Encounter, Coverage, ServiceRequest) via athenahealth's FHIR R4 endpoints, including US Core resources.
• **SMART App Launch:** Enabling context-aware launches of Klivira directly from athenaOne, passing relevant patient and encounter details for efficient workflow initiation.
• **athenahealth Marketplace:** Klivira is designed for deep integration within the athenahealth ecosystem, aligning with the technical requirements for partners listed on the athenahealth Marketplace.
• **Write-back Capabilities:** Depositing prior authorization artifacts, status updates, and approval numbers directly into athenaOne's Chart, Inbox, and Documents sections.
• **Order Entry Hooks:** Leveraging athenahealth's Orders activity to detect services requiring prior authorization at the point of ordering, preventing downstream delays.

Accelerating Prior Authorizations for Clover Health

Klivira automates the submission process for Clover Health prior authorizations, irrespective of the specific submission channel required by Clover. Whether through direct ePA connections, X12 278 transactions, or intelligent automation of payer portal interactions, Klivira ensures that complete clinical documentation is assembled and submitted accurately. This approach significantly reduces the administrative burden on staff and aims to decrease turnaround times for critical Medicare Advantage services.

Enhancing Revenue Cycle Efficiency for athenahealth Users

By automating prior authorizations for Clover Health, athenahealth users can reallocate significant staff time currently spent on manual tasks. This includes reducing the need for multiple portal logins and continuous monitoring of payer-rule churn. Klivira's solution is designed to improve the consistency and accuracy of submissions, contributing to lower denial rates and a more predictable revenue cycle for ambulatory practices and physician groups.

Integrating PA Status and Documentation into athenaOne

Klivira ensures that all prior authorization activities and status updates for Clover Health are seamlessly integrated back into athenaOne. Approved authorizations, denial notifications, and supporting clinical documents are written back to the patient's Chart, appear as tasks in the Inbox, or are deposited into the Documents section. This keeps clinicians and administrative staff informed within their native EMR environment, eliminating the need to toggle between systems for PA status checks.