Accelerate athenahealth SCAN Health Plan Prior Authorization Automation

Klivira delivers intelligent athenahealth SCAN Health Plan prior authorization automation, transforming manual workflows into efficient, EMR-integrated processes for ambulatory practices.

For revenue cycle directors and prior authorization coordinators, navigating the complexities of prior authorizations for SCAN Health Plan members from within athenahealth presents significant challenges. The constant churn of payer rules and the time spent on manual portal logins divert valuable staff resources from patient care, impacting both operational efficiency and revenue integrity.

The Prior Authorization Burden for athenahealth Practices Serving SCAN Health Plan

Ambulatory practices and physician groups utilizing athenahealth frequently face bottlenecks when securing prior authorizations for SCAN Health Plan, a prominent non-profit Medicare Advantage insurer focused on senior care. The manual effort required to manage diverse medical and pharmacy benefit rules, often involving navigating multiple payer-specific portals or phone calls, strains staff and delays patient access to care.

Klivira's Seamless Integration with athenahealth

Klivira integrates directly with athenahealth, leveraging its robust API surface and the athenahealth Marketplace. This deep connectivity allows for the automated extraction of clinical data via FHIR R4 APIs and the intelligent submission of prior authorization requests, minimizing manual data entry and improving accuracy within athenaClinicals and athenaCollector.

Key Integration Capabilities with athenahealth

SMART on FHIR App Launch for contextual access directly from athenaOne.
FHIR R4 API utilization for secure access to patient, encounter, coverage, ServiceRequest, and MedicationRequest data.
Write-back functionality to deposit authorization numbers, status updates, and documents into the athenaClinicals chart and task queues.
Leveraging the athenahealth Marketplace for secure and validated partner integration pathways.
Streamlined data exchange across athenaClinicals and athenaCollector modules for comprehensive PA management.

Optimizing Prior Authorization Workflows for Medicare Advantage

Given SCAN Health Plan's focus on Medicare Advantage, Klivira specifically addresses the prior authorization needs for medications, imaging, and procedures common in senior care. Our platform streamlines the submission process, ensuring that requests align with payer requirements and reducing the likelihood of denials related to missing information or non-adherence to specific policies.

Addressing Common Prior Authorization Pain Points

Klivira directly tackles the prior authorization pain points identified by athenahealth users, such as continuous payer-rule churn and excessive staff time spent on manual portal logins. By automating rule detection and submission, we free up prior authorization coordinators to focus on complex cases, appeals management, and patient advocacy, enhancing overall revenue cycle efficiency.

Enhancing Operational Efficiency and Patient Care

Automating prior authorizations for SCAN Health Plan within your athenahealth environment translates into tangible benefits: faster approval times, fewer administrative denials, and improved staff productivity. This allows your practice to deliver timely, high-quality care to Medicare Advantage members while optimizing revenue cycles and reducing administrative burden.

Frequently asked questions

How does Klivira access patient data from athenahealth for SCAN Health Plan prior authorizations?

Klivira integrates with athenahealth primarily through its FHIR R4 APIs, adhering to US Core profiles, to securely extract relevant patient, encounter, and coverage information. We also utilize SMART App Launch to provide contextual access directly from within athenaOne, ensuring data accuracy and clinician workflow integration, all while maintaining PHI security.

Can Klivira update prior authorization status back into athenahealth?

Yes, Klivira supports robust write-back capabilities to athenahealth. This includes depositing approved authorization numbers directly into the patient's chart, updating task queues with status changes, and attaching prior authorization approval documents to the patient's clinical record in athenaClinicals, streamlining communication and reducing manual updates.

Is Klivira available through the athenahealth Marketplace?

Klivira leverages athenahealth's robust API ecosystem and pathway for partner applications, including those integrated via the athenahealth Marketplace. This ensures a secure, validated integration path, enabling athenahealth users to seamlessly connect with Klivira's prior authorization automation platform and enhance their existing EMR workflows.

How does Klivira handle SCAN Health Plan's specific prior authorization rules?

Klivira maintains an extensive, continuously updated library of payer-specific rules and policies, including those relevant for SCAN Health Plan's Medicare Advantage plans. Our platform intelligently applies these rules during the prior authorization submission process, ensuring that requests meet the payer's criteria and reducing the risk of administrative denials.

What types of prior authorizations does Klivira support for SCAN Health Plan Medicare Advantage members?

Klivira supports a broad range of prior authorizations relevant to Medicare Advantage members, including those for specialty medications, advanced imaging (e.g., MRI, CT scans), durable medical equipment (DME), and various surgical or procedural services. Our automation adapts to the specific requirements of each service line, optimizing for common needs in senior care.