Accelerating athenahealth Molina Healthcare Prior Authorization Automation

The athenahealth-Molina Prior Authorization Challenge

For practices leveraging athenahealth, managing prior authorizations for Molina Healthcare members presents a multifaceted challenge. Molina's extensive footprint across state Medicaid managed care and ACA marketplace plans means navigating a complex web of state-specific policies and submission requirements. Revenue cycle teams frequently encounter high payer-rule churn and spend significant staff time on manual portal logins, often through platforms like Availity, which directly impacts operational efficiency and claim turnaround times.

Klivira's Seamless Integration with athenahealth

Klivira integrates directly with athenaOne, leveraging athenahealth's robust FHIR API and SMART App Launch capabilities. This connection enables Klivira to read critical patient context from the Chart, Orders activity, and Document sections of athenaClinicals. Our platform is designed to launch from within athenaOne, providing a contextualized workflow for prior authorization submissions without disrupting existing clinical workflows, while also supporting standalone launch scenarios.

Navigating Molina Healthcare's Diverse Submission Channels

• **Medical Benefit PA:** Klivira routes medical benefit prior authorizations through Molina's state-specific provider portals, including those accessible via Availity, ensuring adherence to individual state Medicaid managed-care contract requirements.
• **Pharmacy Benefit PA:** For pharmacy prior authorizations, Klivira supports ePA submissions through common partners like CoverMyMeds and Surescripts, adapting to Molina's state-specific PBM relationships.
• **D-SNP and Marketplace Plans:** Our system accounts for the unique dual-eligibility rules of Molina's Medicare Advantage Dual-Special-Needs Plans and the QHP-on-FFM regulations governing their ACA Marketplace offerings.
• **State-Aware Routing:** Klivira's intelligent routing engine ensures that submissions are directed to the correct state-specific Molina channel, reflecting the varied operational specifics across states like California, Texas, Florida, and Ohio.

Compliance and Policy Adherence for Molina Plans

Molina Healthcare's utilization management criteria are published through state-specific provider sites, which Klivira's platform monitors to ensure current policy adherence. Furthermore, all Molina's Medicaid managed-care, D-SNP MA, CHIP, and QHP-on-FFM lines are impacted payers under CMS-0057-F. Klivira's integration applies the correct decision-timeframe expectations per line of business, supporting compliance with both state Medicaid mandates and federal interoperability rules.

Streamlining Key Prior Authorization Workflows

From an athenahealth perspective, Klivira monitors Orders activity to proactively identify services requiring prior authorization. Once an authorization is obtained, Klivira facilitates write-back into athenaOne, depositing the authorization packet as a clinical document and updating the relevant Inbox or Task queues with status and authorization numbers. This ensures that clinical and administrative staff have real-time visibility into authorization statuses for a range of services, from specialty medications to advanced imaging.

Klivira's Differentiated Approach for athenahealth and Molina

Klivira's solution is built to address the specific integration nuances of athenahealth and the operational complexities of Molina Healthcare. By providing a unified platform for prior authorization automation, we reduce the burden of manual data entry, minimize delays caused by payer-rule churn, and ensure state-aware routing for Molina's diverse plans. This strategic partnership empowers your team to focus on patient care rather than administrative overhead.