Drive athenahealth EmblemHealth Prior Authorization Automation

Klivira delivers integrated athenahealth EmblemHealth prior authorization automation, streamlining a historically manual and time-consuming process for healthcare providers.

For athenahealth users managing patient care in New York, navigating EmblemHealth's prior authorization requirements can lead to significant administrative burden and delays. Manual portal logins and the constant churn of payer rules consume valuable staff time, directly impacting revenue cycles and patient access to care.

The Challenge of EmblemHealth Prior Authorizations within athenahealth

Ambulatory practices and physician groups utilizing athenahealth frequently encounter friction when submitting prior authorizations to EmblemHealth. The necessity of navigating multiple payer-specific portals, coupled with EmblemHealth's evolving policy landscape, creates a significant drain on staff resources. This manual workflow, often initiated from within athenaOne, disrupts clinical flow and delays necessary patient treatments.

Klivira's Deep Integration with athenahealth for Prior Authorization Workflows

Klivira integrates directly with athenahealth, leveraging its robust API ecosystem including FHIR R4 and legacy athena-proprietary REST APIs, to automate prior authorization. Our solution can be launched as a SMART App from within athenaOne, providing patient context via standard SMART parameters, or operate as a standalone application authenticating via OAuth 2.0. This ensures seamless data exchange and minimizes workflow disruption.

Streamlining EmblemHealth PA Submissions

Klivira connects to EmblemHealth through various digital channels and ePA pathways, automating the submission and tracking of prior authorizations. By centralizing the PA process, we reduce the need for manual data entry into payer-specific portals, allowing your team to focus on patient care rather than administrative tasks. This connectivity aims to accelerate approval times and reduce denials for your New York-based patient population, including commercial and Medicaid members.

Comprehensive PA Automation for Common Service Lines

Our platform addresses a broad spectrum of prior authorization requirements common in ambulatory practices and multi-specialty groups, including imaging services, specialty medications, and surgical procedures. By intelligently detecting PA needs from athenaOne's Orders activity and reading clinical context from the Chart, Klivira helps ensure that EmblemHealth submissions are complete and accurate, aligning with payer guidelines.

Key Integration Capabilities with athenahealth

Read patient demographics, encounters, and clinical documentation via FHIR R4 US Core resources.
Detect prior authorization requirements from athenaOne's Orders activity.
Post prior authorization status updates directly to athenaOne's Inbox and Task queues.
Deposit completed prior authorization packets and approval letters into the Documents / Clinical Documents section of the patient Chart.
Utilize SMART App Launch for context-aware workflows directly within athenaClinicals.
Support write-back of authorization numbers to relevant orders where API surface allows.

Enhancing Revenue Cycle and Patient Access

By automating athenahealth EmblemHealth prior authorization, Klivira directly contributes to a more efficient revenue cycle and improved patient access. Reducing the time spent on manual PA processes minimizes staff overhead and accelerates treatment initiation, leading to fewer claim denials and a healthier financial outlook for your practice. This automation supports compliance considerations, which should be discussed with your compliance team.

Frequently asked questions

How does Klivira integrate with athenahealth to pull patient data for EmblemHealth PAs?

Klivira integrates with athenahealth primarily through its FHIR R4 APIs, leveraging US Core resources like Patient, Encounter, Coverage, and ServiceRequest. This allows our platform to securely access the necessary clinical context and patient demographics directly from athenaOne to build comprehensive prior authorization requests for EmblemHealth, including for their commercial and Medicaid plans.

Can Klivira write prior authorization status updates back into athenahealth?

Yes, Klivira supports write-back capabilities to athenahealth. We can post prior authorization status updates directly to athenaOne's Inbox or Task queues and deposit approved authorization letters or completed packets into the Documents / Clinical Documents section of the patient chart, streamlining internal communication and record-keeping.

Is Klivira available on the athenahealth Marketplace?

Klivira engages with the athenahealth Marketplace program to offer our prior authorization automation solution to athenaOne customers. We go through athenahealth's review process to ensure our integration meets their standards for partner applications and delivers value to their user base.

How does Klivira handle the specific prior authorization requirements for EmblemHealth in New York?

Klivira maintains connectivity to EmblemHealth through various digital channels and ePA pathways. Our system is designed to adapt to payer-specific rules and submission formats, helping ensure that prior authorization requests for EmblemHealth are submitted accurately and efficiently, reducing the likelihood of denials for your New York-based practice.

What kind of prior authorizations can Klivira automate for athenahealth users submitting to EmblemHealth?

Klivira automates a wide range of prior authorizations, including those for imaging, specialty medications, and various surgical procedures, which are common for ambulatory practices and physician groups using athenahealth. Our platform is configurable to address the specific service lines and codes that frequently require prior authorization from EmblemHealth.