Centricity Aetna Prior Authorization Automation

Klivira delivers robust **Centricity Aetna prior authorization automation**, transforming manual workflows into efficient, integrated processes for healthcare organizations.

For revenue cycle directors and prior authorization coordinators utilizing Centricity (including legacy GE Centricity installs now under athenahealth) to manage Aetna payer interactions, the complexity of diverse submission channels and policy adherence can lead to significant administrative burden and delayed care. Klivira addresses these operational challenges by automating critical steps, ensuring that prior authorization requests are submitted accurately and efficiently.

Navigating Aetna Prior Authorizations from Centricity

The process of securing prior authorization from Aetna, whether for medical or pharmacy benefits, often involves navigating multiple portals and communication methods. For Centricity users, this traditionally means manual data entry into the Availity portal for medical requests, or utilizing ePA partners like CoverMyMeds or Surescripts for pharmacy benefits. Klivira centralizes these disparate workflows, connecting directly with your Centricity EMR to streamline submissions.

Klivira's Centricity Integration for Aetna Workflows

Klivira integrates with Centricity via Athena APIs, enabling seamless data exchange for prior authorization requests. This direct connectivity minimizes manual intervention, pulling necessary patient demographics, clinical notes, and order details directly from the EMR. Our platform then intelligently routes requests to Aetna's preferred channels, including Availity for medical benefit precertifications and X12 278 transactions via clearinghouses, or to ePA partners for pharmacy benefit PAs.

Optimizing Aetna's Diverse Submission Channels

Aetna's prior authorization submission channels vary significantly by benefit category. Klivira's platform is configured to adapt to these requirements, ensuring requests are sent through the correct pathway. For medical PA (commercial and Medicare Advantage), Klivira supports routing through the Availity provider portal and X12 278 transactions. For pharmacy PA, including outpatient retail and mail-order, our system integrates with Aetna's ePA partners, CoverMyMeds and Surescripts, to facilitate electronic submissions.

Managing Aetna Clinical Policy Bulletins (CPBs)

Aetna's medical-necessity criteria are published as Clinical Policy Bulletins (CPBs), which are regularly updated and versioned. Klivira's automation platform incorporates robust policy management capabilities, helping your team stay current with the latest Aetna CPBs. This ensures that submitted documentation aligns with specific medical necessity criteria, reducing the likelihood of denials related to insufficient or incorrect information.

Addressing Turnaround Times and Regulatory Requirements

Aetna's prior authorization turnaround times are influenced by state-mandated minimums, payer-published service-level targets, and NCQA Utilization Management accreditation standards. For Aetna's Medicare Advantage, Medicaid, and QHP-on-FFM lines of business, CMS-0057-F introduces specific requirements for electronic prior authorization and decision timeframes. Klivira's automation helps accelerate the submission process, enabling your team to meet these varied deadlines and improve compliance posture.

Frequently asked questions

How does Klivira integrate with Centricity for Aetna prior authorizations?

Klivira integrates with Centricity via Athena APIs, establishing a direct connection to pull necessary patient and clinical data. This integration automates the extraction of information required for Aetna prior authorization requests, reducing manual data entry and ensuring data accuracy.

Which Aetna prior authorization channels does Klivira support?

Klivira supports Aetna's primary prior authorization channels. For medical benefit requests, this includes routing through the Availity provider portal and X12 278 transactions. For pharmacy benefit prior authorizations, Klivira integrates with Aetna's ePA partners, CoverMyMeds and Surescripts.

How does Klivira help manage Aetna's Clinical Policy Bulletins (CPBs)?

Klivira's platform is designed to incorporate dynamic policy intelligence, assisting your team in adhering to Aetna's Clinical Policy Bulletins (CPBs). By streamlining access to and application of these criteria, we help ensure that prior authorization requests are submitted with the required clinical documentation, minimizing denials.

Does Klivira address Aetna's pharmacy benefit prior authorizations?

Yes, Klivira supports pharmacy benefit prior authorizations for Aetna members, which are administered through CVS Caremark. Our system facilitates electronic submissions via Aetna's ePA partners, CoverMyMeds and Surescripts, for outpatient retail and mail-order prescriptions.

Is Klivira compatible with CMS-0057-F requirements for Aetna Medicare Advantage PA?

Klivira's platform is designed to align with evolving regulatory landscapes, including the requirements of CMS-0057-F for impacted payers like Aetna's Medicare Advantage lines. Our automation capabilities help healthcare organizations prepare for and meet the rule's phased compliance timeline for electronic prior authorization and decision timeframes. Please discuss specific compliance considerations with your legal and compliance teams.