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Streamlining Centricity Prior Authorization for Oncology Workflows

Klivira automates Centricity prior authorization for oncology, transforming complex, high-volume cancer care PA into an efficient, integrated process.

For revenue cycle directors, prior authorization coordinators, and IT leads managing Centricity EMR environments, the demands of oncology prior authorization present unique challenges. High-cost therapies, frequent regimen changes, and urgent treatment timelines often collide with manual PA processes. Klivira provides a specialized solution designed to navigate these complexities within your Centricity ecosystem.

The Oncology Prior Authorization Imperative in Centricity Environments

Oncology prior authorization is among the most complex and volume-intensive segments of healthcare. For clinics and health systems utilizing Centricity (including legacy GE Centricity installs being migrated), navigating the constant need for approvals for high-cost biologics, infusion therapy, and radiation oncology can strain operational resources. Klivira addresses this by integrating directly with your EMR to streamline the PA process, ensuring critical cancer treatments are not delayed.

Key Prior Authorization Triggers in Oncology

  • HCPCS J-codes for chemotherapy and biologic infusions, including immunotherapies and targeted therapies.
  • Advanced imaging for staging and surveillance (PET/CT, advanced MRI, tumor-specific molecular imaging).
  • Radiation oncology procedures (IMRT, IGRT, SBRT, brachytherapy, proton-beam therapy CPT ranges).
  • Genetic and molecular testing for treatment selection and risk stratification.
  • Supportive care medications such as growth factors (G-CSF, ESAs) and antiemetics.

Klivira's Seamless Integration with Centricity for Oncology PA

Klivira integrates with Centricity EMRs, leveraging the underlying Athena APIs to automate prior authorization workflows for oncology. This integration allows for the automated extraction of clinical data from patient charts, which is critical for supporting medical necessity for chemotherapy regimens, biologics, and radiation therapy. By operating within your existing Centricity framework, Klivira reduces manual data entry and accelerates the submission process, particularly valuable for legacy installs being migrated.

Critical Documentation for Oncology Prior Authorizations

  • Diagnosis confirmation, including pathology reports, tumor staging (AJCC TNM), and relevant molecular markers (e.g., ER/PR/HER2, EGFR/ALK/PD-L1).
  • Documentation of prior-line treatment response and rationale for subsequent regimens.
  • Performance status (ECOG or Karnofsky score) supporting fitness for treatment.
  • Comorbidities, contraindications, and organ function relevant to the proposed regimen.
  • For off-label use, NCCN Compendium citation (Category 1, 2A, 2B) with specific tumor type and clinical context.

Navigating Medical vs. Pharmacy Benefit for Oncology Drugs

Oncology drugs are uniquely split between medical benefit (provider-administered infusions via X12 278) and pharmacy benefit (oral oncolytics via PBMs and ePA platforms). Klivira's platform intelligently routes prior authorization requests based on the specific drug and benefit type, ensuring accurate and timely submission whether it's an IV biologic or an oral targeted therapy. This dual-channel capability is critical for comprehensive oncology PA management within Centricity.

Proactive Strategies Against Common Oncology PA Denials

Oncology prior authorization requests frequently face denials due to reasons such as off-label use without sufficient compendium support, step therapy requirements, and documentation gaps. Klivira's NCCN-compendium-aware policy logic helps prevent these by surfacing required documentation at the point of order entry within Centricity, proactively addressing common pitfalls and reducing the need for appeals and peer-to-peer reviews.

Frequently asked questions

How does Klivira handle the high volume of PA events for a single oncology patient?

Klivira's platform tracks concurrent PA events for individual oncology patients, managing dozens of requests across diagnosis, staging, treatment initiation, regimen changes, supportive care, and surveillance imaging. This comprehensive tracking ensures no PA is missed and reduces administrative burden.

Can Klivira support both medical and pharmacy benefit oncology PAs within Centricity?

Yes, Klivira manages both medical benefit (IV infusions, X12 278) and pharmacy benefit (oral oncolytics, ePA via PBMs) prior authorizations. Our system intelligently routes requests through the appropriate payer channels, ensuring all oncology drug types are covered seamlessly within your Centricity workflow.

How does Klivira integrate with Centricity's data for oncology-specific documentation?

Klivira integrates with Centricity via Athena APIs to extract critical clinical data, such as pathology reports, molecular markers, prior treatment history, and performance status. This data is then automatically compiled to meet NCCN-guideline-based documentation requirements for oncology PA submissions.

What role do NCCN guidelines play in Klivira's oncology PA automation?

Klivira incorporates NCCN Clinical Practice Guidelines and the NCCN Drugs & Biologics Compendium into its policy logic. This allows the platform to identify and prompt for specific documentation required for medical necessity, especially for off-label drug use, directly at the point of order entry within Centricity.

How does Klivira help with urgent start-of-treatment scenarios in oncology?

By automating data extraction, submission, and tracking, Klivira significantly reduces the PA cycle time. This acceleration is crucial for urgent start-of-treatment scenarios in oncology, helping to minimize delays that can impact patient outcomes and ensuring timely access to critical therapies.

Related coverage

Other centricity prior auth coverage

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