Optimizing athenahealth Devoted Health Prior Authorization Automation

The Challenge of Devoted Health Prior Authorizations in athenahealth

Ambulatory practices utilizing athenahealth frequently encounter inefficiencies when processing prior authorizations for Devoted Health's Medicare Advantage plans. The process often involves navigating diverse payer portals and managing the churn of specific payer rules, consuming valuable staff time better spent on patient care. Klivira's platform is designed to mitigate these prior authorization pain points, centralizing the submission and tracking process.

Seamless Integration with athenahealth

Klivira integrates with athenahealth through a combination of its robust API surfaces, including FHIR-conformant endpoints and legacy athena-proprietary REST APIs, ensuring comprehensive data exchange. Our solution can be accessed via the athenahealth Marketplace and leverages SMART App Launch for contextual workflows directly within athenaOne. This approach minimizes disruption, allowing practices to manage prior authorizations without leaving their core EMR environment.

Streamlining Devoted Health PA Workflows for Ambulatory Care

• **Automated Submission:** Initiate Devoted Health prior authorization requests directly from athenahealth, leveraging clinical data from the patient's chart.
• **Real-time Status Updates:** Receive automated status notifications and updates, which can be configured to populate athenaOne's Inbox / Task queues.
• **Documentation Exchange:** Securely transmit necessary clinical documentation, including scanned attachments and partner-uploaded packets, directly to Devoted Health, with write-back capabilities to athenahealth's Documents / Clinical Documents section.
• **Medicare Advantage Specifics:** Navigate the unique requirements and medical policies of Devoted Health's Medicare Advantage plans, covering services from specialty medications to advanced imaging.
• **Reduced Manual Effort:** Eliminate the need for multiple manual portal logins, reducing staff time on administrative tasks and improving overall operational efficiency.

Data Exchange and Write-Back for Comprehensive Workflow Management

Klivira utilizes athenahealth's FHIR R4 read APIs, covering US Core resources such as Patient, Encounter, Coverage, ServiceRequest, and MedicationRequest, to gather necessary clinical context. For prior authorization artifacts, our integration supports write-back capabilities to athenahealth's Chart, updating Orders activity with authorization numbers, and depositing partner-supplied PA packets as clinical documents. This ensures that all relevant prior authorization information is accessible within athenaClinicals and athenaCollector, maintaining a single source of truth.

Navigating Medicare Advantage Prior Authorization Nuances with Devoted Health

Devoted Health, as a Medicare Advantage focused insurer, operates with specific medical policies and formularies that require precise navigation for prior authorization approvals. Klivira's platform is designed to adapt to these nuances, helping athenahealth users process authorizations for services commonly requiring PA in Medicare Advantage, such as certain specialty drugs, durable medical equipment, and complex diagnostic imaging. This targeted approach helps reduce denial rates and accelerates patient access to care.