Centricity Anthem (Elevance Health) Prior Authorization Automation

Klivira provides comprehensive Centricity Anthem (Elevance Health) prior authorization automation, streamlining complex medical and pharmacy benefit workflows for efficient approvals.

Revenue cycle directors and prior authorization coordinators managing Centricity EMR environments face significant challenges navigating Anthem (Elevance Health) prior authorizations. Klivira integrates directly with Centricity to automate submissions across Anthem's diverse channels, reducing administrative burden and accelerating decision times.

The Centricity-Anthem Prior Authorization Workflow Challenge

Managing prior authorizations for Anthem-licensed plans from a Centricity EMR involves navigating multiple payer portals and submission methods. This often leads to fragmented workflows, manual data entry, and delays in care. Klivira addresses these operational friction points by centralizing the PA process.

Klivira's Integration with Centricity EMR

Klivira connects directly with your Centricity EMR environment, leveraging Athena APIs to securely extract necessary patient demographics, clinical documentation, and order details. This integration minimizes manual data abstraction, ensuring that prior authorization requests are comprehensive and consistent with the patient's record.

Navigating Anthem (Elevance Health) Prior Authorization Channels

Anthem (Elevance Health) utilizes a multi-channel approach for prior authorization submissions, depending on the service and benefit. Klivira intelligently routes requests to the correct destination, adapting to Anthem's specific requirements for medical, pharmacy, and specialty services.

Key Anthem Submission Channels Supported:

**Medical Benefit PA:** Submissions via Availity Essentials for commercial and Medicare Advantage plans, including X12 278 transactions through clearinghouses.
**Pharmacy Benefit PA:** Retail pharmacy PA processed through CarelonRx (formerly IngenioRx), utilizing CoverMyMeds and Surescripts ePA for prescriber-initiated workflows.
**Specialty Services:** Advanced imaging, cardiology, musculoskeletal, sleep, and radiation oncology requests routed through the Carelon Medical Benefits Management (formerly AIM Specialty Health) provider portal.
**Specialty Drug PA (Medical Benefit):** Submissions for specialty injectables and infusions, adhering to Anthem's site-of-care and clinical-indication policies, potentially routed via Carelon.
**Behavioral Health PA:** Managed through Carelon Behavioral Health (formerly Beacon Health Options) for specific lines of business, requiring verification of carve-out status.

Automated Policy Adherence and Denial Prevention

Klivira helps ensure prior authorization requests align with Anthem's specific medical policies and clinical guidelines. This includes referencing policy libraries accessible via Availity for Anthem-developed criteria and the Carelon MBM provider site for specialty service guidelines. By automating documentation assembly and review, Klivira addresses common denial patterns such as medical necessity, step therapy, and site-of-service mismatch.

Accelerating Turnaround Times and Compliance

Automation with Klivira aids in meeting critical prior authorization turnaround times, including state-mandated minimums for commercial plans and the expedited 72-hour (standard) / 24-hour (expedited) requirements for Medicare Advantage and Medicaid managed-care plans under CMS-0057-F. This proactive approach supports faster patient access to care and reduces administrative backlogs.

Frequently asked questions

How does Klivira integrate with Centricity for Anthem prior authorizations?

Klivira integrates with your Centricity EMR using Athena APIs to securely extract patient data and clinical documentation. This direct connection streamlines the process of gathering the necessary information for Anthem prior authorization submissions, minimizing manual data entry.

Which Anthem (Elevance Health) prior authorization channels does Klivira support?

Klivira supports a comprehensive range of Anthem (Elevance Health) channels, including Availity Essentials for medical benefit PAs, X12 278 transactions, Carelon Medical Benefits Management for specialty services, and ePA partners like CoverMyMeds and Surescripts for pharmacy benefits.

Can Klivira assist with specialty drug prior authorizations for Anthem?

Yes, Klivira automates the submission process for specialty drug prior authorizations, including those for injectables and infusions on the medical benefit. Our system helps ensure requests align with Anthem's specific site-of-care and clinical-indication policies, routing them to the appropriate Anthem or Carelon channels.

How does Klivira help ensure I'm using the correct Anthem medical policy?

Klivira assists teams in navigating Anthem's diverse policy landscape. This includes directing users to the appropriate medical policies and clinical guidelines published on Anthem provider sites (via Availity) and Carelon Medical Benefits Management's specific criteria, ensuring submissions are aligned with the payer's current requirements.

Does Klivira improve turnaround times for Anthem prior authorizations?

By automating data extraction, form population, and intelligent routing, Klivira significantly reduces the manual effort and potential for errors in Anthem prior authorization submissions. This operational efficiency contributes to faster processing times, helping clinics meet state-mandated minimums and CMS-0057-F requirements for Medicare Advantage and Medicaid.