Centricity Cigna Prior Authorization Automation

Klivira enables robust Centricity Cigna prior authorization automation, bridging the gap between your EMR and Cigna Healthcare's diverse submission channels.

For revenue cycle directors and prior authorization coordinators, managing the volume and complexity of prior authorizations for Cigna patients within a Centricity environment presents unique operational challenges. From varied submission portals to evolving policy requirements, manual workflows can lead to delays and increased administrative burden. Klivira's platform is engineered to streamline this critical process.

Connecting Centricity to Cigna Prior Authorization Workflows

Centricity, as a legacy GE EHR now under athenahealth, requires integration strategies that leverage modern API capabilities. Klivira integrates with Centricity via Athena APIs, enabling a seamless flow of patient data and authorization requests. This integration allows for the initiation and tracking of Cigna prior authorizations directly from your EMR, reducing the need for manual data entry and portal navigation.

Streamlining Cigna Prior Authorization Channels

**Medical Benefit PAs:** Klivira connects to Cigna Healthcare's provider portal, CignaforHCP.com, for medical benefit prior authorization initiation, status checks, and document uploads. X12 278 transactions are also supported via clearinghouses for applicable procedures.
**Pharmacy Benefit PAs:** For pharmacy benefit prior authorizations, Klivira routes requests through Evernorth's Express Scripts PBM system and integrates with ePA partners like CoverMyMeds and Surescripts for prescriber-initiated workflows.
**Specialty Drug PAs:** Specialty injectable and complex medication PAs on the pharmacy benefit are managed through Accredo, under the Evernorth brand. Medical-benefit specialty drugs follow Cigna Healthcare's standard medical PA channel, with site-of-care and clinical-indication policies applied.
**Policy Adherence:** Klivira's platform incorporates Cigna Healthcare's published coverage policies and medical-necessity guidelines, including those citing MCG or NCCN compendium criteria, to support accurate submission and reduce denials.

Navigating Cigna's Policy and Utilization Management

Cigna Healthcare publishes extensive coverage policies and medical-necessity guidelines on its public provider site. These policies are versioned and dated, covering a range of services from advanced imaging to oncology drugs. Klivira's system is designed to help your team align submissions with these specific criteria, referencing policy numbers and effective dates, thereby improving the likelihood of initial approval.

Enhancing Compliance and Turnaround Times

For Cigna's Medicare Advantage and Qualified Health Plan (QHP) lines on the Federal Facilitated Marketplace, prior authorization timeframes are impacted by CMS-0057-F, mandating 72-hour standard and 24-hour expedited PA responses on a phased compliance timeline. Klivira's automation capabilities support adherence to these federal mandates, alongside state-specific commercial PA regulations, by accelerating submission and tracking processes. This helps your organization meet payer-published service-level targets and regulatory requirements.

Leveraging Da Vinci and Electronic PA Capabilities

Cigna Healthcare participates in the HL7 Da Vinci Project ecosystem, indicating a strategic direction towards electronic prior authorization (ePA) standards like PAS, CRD, and DTR. Separately, Evernorth's Express Scripts has long-established ePA capabilities through CoverMyMeds and Surescripts for retail pharmacy benefits. Klivira is built to leverage these electronic pathways, optimizing the data exchange required for efficient prior authorization processing.

Frequently asked questions

How does Klivira integrate with Centricity for Cigna prior authorizations?

Klivira integrates with Centricity via Athena APIs, which allows for the extraction of necessary patient and clinical data directly from your EMR. This data is then used to populate and submit prior authorization requests to Cigna Healthcare's various channels, reducing manual effort and potential errors.

Which Cigna prior authorization channels does Klivira support?

Klivira supports medical benefit prior authorizations through CignaforHCP.com and X12 278 transactions. For pharmacy benefits, we connect to Evernorth's Express Scripts PBM system and ePA partners like CoverMyMeds and Surescripts. Specialty drug PAs are routed via Accredo for pharmacy benefit and Cigna Healthcare's medical channel for medical benefit.

Can Klivira help with Cigna's medical necessity guidelines?

Yes, Klivira's platform helps your team align prior authorization submissions with Cigna Healthcare's published coverage policies and medical-necessity guidelines. By facilitating access to and application of these criteria, including those based on MCG or NCCN, we aim to improve submission accuracy and reduce denial rates.

How does Klivira address CMS-0057-F requirements for Cigna PAs?

Klivira's automation capabilities support compliance with CMS-0057-F for Cigna Healthcare's Medicare Advantage and QHP lines by accelerating the initiation and tracking of prior authorization requests. This helps ensure submissions meet the mandated 72-hour standard and 24-hour expedited timeframes, contributing to improved operational efficiency and regulatory adherence.

Does Klivira support prior authorization for specialty drugs with Cigna?

Yes, Klivira supports prior authorization for specialty drugs. For pharmacy benefit specialty drugs, requests are routed through Accredo, an Evernorth company. For medical benefit specialty drugs, submissions follow Cigna Healthcare's standard medical PA channel, ensuring appropriate clinical and site-of-care policies are addressed.