Streamlining athenahealth Prior Authorization for DME

Klivira automates athenahealth prior authorization for DME, tackling the complexities of high-volume durable medical equipment approvals directly within your EMR.

Revenue cycle leaders and prior authorization coordinators face significant challenges managing DME prior authorizations, particularly with varying payer rules and the administrative burden of manual processes. Integrating a dedicated PA solution with athenahealth is critical for enhancing efficiency and reducing denial rates for ambulatory practices and physician groups.

Navigating Durable Medical Equipment Prior Authorization within athenahealth

Ambulatory practices and physician groups utilizing athenahealth frequently manage prior authorizations for durable medical equipment (DME), including high-volume categories such as power mobility, CPAP/BiPAP, prosthetics/orthotics, and ostomy supplies. These workflows are often complicated by constant payer-rule churn and the significant staff time spent on manual portal logins, directly impacting revenue cycle efficiency.

Klivira's Integration Architecture with athenahealth for DME Workflows

Klivira integrates with athenahealth leveraging its robust API ecosystem, including FHIR R4 endpoints for US Core resources and legacy athena-proprietary REST APIs, ensuring comprehensive coverage of PA-relevant workflows. Our solution is designed for seamless deployment via the athenahealth Marketplace, providing a certified pathway for athenaOne customers.

Key athenahealth Integration Points for DME Prior Authorization

**FHIR R4 APIs**: Accessing patient context, encounters, coverage, and service requests (Patient, Encounter, Coverage, ServiceRequest) to pre-populate PA forms.
**SMART App Launch**: Enabling contextual app launches directly from athenaOne, passing patient and encounter data for specific DME orders.
**Write-back Capabilities**: Depositing authorization numbers into Orders activity and full PA packets as clinical documents within athena's Documents section.
**athenahealth Marketplace**: Providing a verified channel for Klivira's integration, ensuring compatibility and streamlined access for athenaOne users.
**Legacy API Support**: Maintaining dual code paths where necessary to cover PA-relevant workflows still transitioning from proprietary APIs to FHIR.

Automating High-Volume DME Categories in athenaOne

Klivira specifically targets the prior authorization complexities of high-volume DME categories common in athenahealth-powered practices. By integrating directly with athenaOne's Orders activity, our platform can detect orders for items like power mobility or CPAP/BiPAP and automatically initiate the appropriate PA workflow, reducing manual triggers and potential delays.

Managing Prior Authorization Artifacts within athenaOne's Chart

Effective prior authorization management requires clear documentation within the EMR. Klivira ensures that all PA artifacts, including authorization numbers, approval letters, and supporting clinical documentation, are systematically written back into athenaOne. These documents are accessible in the Clinical Documents section, providing a comprehensive audit trail within the patient's Chart.

Operational Efficiency for athenahealth DME Providers

By automating the collection of clinical data from athenaClinicals and populating payer-specific forms, Klivira significantly reduces the administrative burden on prior authorization coordinators. This efficiency gain allows staff to focus on complex cases and patient care, rather than repetitive data entry and navigating disparate payer portals for DME approvals.

Frequently asked questions

How does Klivira address the specific prior authorization pain points for DME providers using athenahealth?

Klivira directly tackles athenahealth's identified pain points for DME prior authorization by automating data extraction from athenaClinicals, reducing the need for manual portal logins, and streamlining submissions for high-volume DME categories like power mobility and CPAP/BiPAP, thereby mitigating payer-rule churn.

What athenahealth APIs does Klivira utilize for DME prior authorization workflows?

Klivira leverages athenahealth's FHIR R4 APIs for US Core resources such as Patient, Encounter, Coverage, and ServiceRequest to gather clinical context. We also utilize legacy athena-proprietary REST APIs to ensure comprehensive coverage for PA-relevant workflows that may still reside outside the current FHIR surface.

Can Klivira write prior authorization status and documents back into athenaOne?

Yes, Klivira supports write-back capabilities to athenaOne. This includes depositing authorization numbers into the Orders activity and uploading complete prior authorization packets as clinical documents into the Documents section of the patient's Chart, subject to specific resource matrix and customer-side configuration.

How does Klivira integrate into the athenaOne user experience for prior authorization?

Klivira integrates seamlessly through the athenahealth Marketplace and supports SMART App Launch. This allows users to launch Klivira directly from within athenaOne with patient context, streamlining the initiation of prior authorization workflows for DME orders.

What are the common operator quirks to consider when integrating a PA solution with athenahealth?

Operators should be aware of athena's ongoing transition from legacy proprietary APIs to FHIR, which may require dual code paths for some PA workflows. While athena is cloud-hosted, per-customer configuration in athenaOne can still affect feature enablement, and sandbox data may differ from production environments.

Is athenaOne compliant with ONC Cures Update API requirements for interoperability?

Yes, athenaOne is listed on the CHPL (Certified Health IT Product List) with ONC Cures Update API certification status, demonstrating its adherence to modern interoperability standards, including those relevant for exchanging health information for prior authorization.