athenahealth Fidelis Care Prior Authorization Automation

Klivira delivers comprehensive athenahealth Fidelis Care prior authorization automation, empowering ambulatory practices and physician groups to navigate complex payer requirements efficiently.

Revenue cycle directors and prior authorization coordinators face significant challenges managing prior authorizations for Fidelis Care patients within athenahealth. The manual burden of navigating payer portals and the constant churn of payer rules contribute to staff burnout and delayed patient care. Klivira provides a purpose-built solution to address these specific operational pain points.

The Challenge: Manual Prior Authorizations for Fidelis Care in athenahealth

Ambulatory practices using athenahealth frequently encounter friction when processing prior authorizations for Fidelis Care, a prominent Medicaid and Medicare plan in New York. The process often involves staff manually logging into the Fidelis Care portal, re-keying patient and clinical data already present in athenaOne, and tracking authorization statuses outside the EMR. This labor-intensive approach leads to significant staff time on portal logins and contributes to payer-rule churn.

Seamless Integration with athenahealth via FHIR and Marketplace

Klivira integrates directly with athenahealth, leveraging its robust API surface and the athenahealth Marketplace. Our solution utilizes FHIR R4 read APIs to pull critical patient, encounter, coverage, and service request data from athenaClinicals. This SMART App Launch-enabled integration allows Klivira to launch from within athenaOne with patient context, streamlining data exchange and minimizing manual data entry for prior authorization requests.

Automating Fidelis Care Prior Authorizations

Klivira's platform automates the submission of prior authorizations to Fidelis Care across various channels. By intelligently routing requests, we reduce the need for manual portal interactions. For Fidelis Care's Medicaid and Medicare lines of business in New York, Klivira ensures that requests are submitted with the necessary clinical documentation, reducing submission errors and accelerating approval times.

Key Prior Authorization Workflows for Fidelis Care Patients

Our automation addresses critical prior authorization workflows common for Fidelis Care's patient population. This includes prior authorizations for specialty medications, advanced diagnostic imaging, durable medical equipment, and various surgical procedures. By integrating with athenahealth's Orders activity and Documents sections, Klivira ensures that PA requests are initiated promptly and supporting clinical documentation is readily available for submission.

Maintaining Data Integrity and Compliance

Klivira prioritizes the secure and compliant handling of PHI throughout the prior authorization process. Our integration with athenahealth supports write-back capabilities, allowing approved authorization numbers and status updates to be recorded directly into the patient's chart or athenaOne's Inbox/Task queues. This ensures that clinical and administrative teams have real-time visibility into authorization status, maintaining data integrity and supporting audit readiness. Organizations should discuss specific data handling and compliance considerations with their internal compliance teams.

Benefits for athenahealth Practices Serving Fidelis Care

Implementing Klivira for athenahealth Fidelis Care prior authorization automation delivers tangible benefits. Practices can expect to reduce the administrative burden on their staff, minimize delays in patient care due to pending authorizations, and improve overall operational efficiency. By leveraging athenahealth's cloud-native architecture, Klivira provides a scalable solution that adapts to evolving payer requirements and practice growth.

Frequently asked questions

How does Klivira integrate with athenahealth for Fidelis Care prior authorizations?

Klivira integrates with athenahealth using FHIR R4 APIs and SMART App Launch, enabling direct data exchange from athenaClinicals. This allows our platform to pull patient and clinical context, and write back authorization statuses and documentation into athenaOne, streamlining the PA workflow.

What types of services require prior authorization from Fidelis Care that Klivira can help with?

Klivira automates prior authorizations for a broad range of services frequently requiring approval from Fidelis Care, including specialty medications, advanced diagnostic imaging, certain surgical procedures, and durable medical equipment. This covers common needs for their Medicaid and Medicare members in New York.

Can Klivira help with Medicaid and Medicare prior authorizations for Fidelis Care patients?

Yes, Klivira's platform is designed to handle prior authorizations for both Medicaid and Medicare lines of business offered by Fidelis Care in New York. We adapt to the specific requirements and submission channels for each plan type, ensuring accurate and timely submissions.

How does Klivira reduce manual work for athenahealth users submitting to Fidelis Care?

By integrating directly with athenahealth, Klivira eliminates the need for manual data re-entry into payer portals. Our automation intelligently routes requests, tracks statuses, and updates athenaOne, significantly reducing staff time spent on portal logins and follow-up.

Is Klivira part of the athenahealth Marketplace?

Klivira engages with the athenahealth Marketplace program to ensure seamless integration and accessibility for athenaOne customers. This partnership facilitates a certified and secure connection, aligning with athenahealth's developer ecosystem standards.