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Centricity VA Community Care Prior Authorization Automation

Klivira delivers robust Centricity VA Community Care prior authorization automation, specifically designed to streamline the complex workflows inherent in veteran healthcare.

For clinics and health systems leveraging Centricity for their EMR, navigating the unique requirements of VA Community Care can present significant prior authorization challenges. The need to efficiently process approvals for veterans accessing care outside VA facilities, often through contractor portals, demands a specialized automation solution.

The Centricity-VA Community Care Prior Authorization Challenge

Submitting prior authorizations for VA Community Care patients from a Centricity environment often involves manual data extraction and re-entry into contractor portals like Optum or TriWest. This fragmented workflow introduces delays, increases administrative burden, and risks submission errors, directly impacting access to care for veterans.

Klivira's Integration with Centricity via Athena APIs

Klivira integrates directly with Centricity installations through the robust Athena APIs, leveraging the modern connectivity framework. This deep integration allows Klivira to securely access necessary patient demographic and clinical data within Centricity, automating the preparation and submission of prior authorization requests without disrupting EMR workflows.

Streamlining VA Community Care Submissions

Klivira automates the submission process for VA Community Care prior authorizations, whether through direct X12 278 transactions where supported, or by intelligently interacting with the Optum and TriWest payer portals. This ensures requests are routed correctly and efficiently, adhering to the specific requirements of the Community Care Network.

Key Prior Authorization Workflows Automated for VA Community Care

  • Specialty Drug ePA for high-cost biologics and complex pharmacotherapy.
  • Imaging and Advanced Diagnostic PA, routing requests to relevant RBMs.
  • Surgical and Inpatient Procedure PA, ensuring timely approval for critical interventions.
  • Durable Medical Equipment (DME) and Prosthetics PA.
  • Referral Management for out-of-network specialists within the VA CCN.

Addressing Complex Service Lines for Veterans

Klivira's platform is configured to manage the specific complexities of prior authorizations for service lines frequently accessed by veterans. This includes, but is not limited to, advanced pain management therapies, mental health services, and rehabilitation programs, ensuring appropriate clinical documentation is compiled and submitted.

Enhanced Compliance and Oversight

Automating prior authorizations with Klivira provides a comprehensive audit trail for all VA Community Care submissions, enhancing transparency and supporting compliance efforts. This digital record-keeping is crucial for demonstrating adherence to payer requirements and internal policies, reducing potential audit risks.

Frequently asked questions

How does Klivira handle the different VA Community Care contractors (Optum/TriWest) when integrating with Centricity?

Klivira's platform is designed to recognize and adapt to the specific submission pathways required by Optum (East) and TriWest (West) within the VA Community Care Network. Integrating with Centricity via Athena APIs, Klivira intelligently routes and formats prior authorization requests based on the patient's region and the contractor's requirements, whether through direct electronic channels or automated portal interaction.

Can Klivira automate prior authorizations for specialty medications prescribed in Centricity for VA Community Care patients?

Yes, Klivira excels in automating specialty drug ePA workflows. For Centricity users, Klivira extracts necessary clinical data from the EMR via Athena APIs and populates the specific forms and fields required by VA Community Care contractors for specialty medications, including biologics and other high-cost therapies, accelerating approval times.

What data from Centricity does Klivira access for prior authorizations?

Klivira securely accesses relevant patient demographic information, diagnoses, ordered procedures, medications, and clinical notes from Centricity through established Athena APIs. This data is used solely for the purpose of generating and submitting accurate prior authorization requests, adhering to strict PHI protocols.

Does Klivira support X12 278 submissions for VA Community Care?

Klivira supports X12 278 transactions where available and preferred by VA Community Care contractors or their delegated entities. For instances where direct electronic submission is not feasible, Klivira also automates interactions with payer portals, ensuring comprehensive coverage for all prior authorization pathways.

How does Klivira improve turnaround times for VA Community Care prior authorizations from Centricity?

By eliminating manual data entry, automating submission routing, and proactively identifying missing information, Klivira significantly reduces the administrative time spent on prior authorizations. This efficiency, combined with real-time status tracking, helps accelerate approvals for VA Community Care patients, improving access to timely care.

Related coverage

Other centricity prior auth coverage

Other EMR integrations for va-cca

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