Oracle Health (Cerner) Aetna Prior Authorization Automation

Klivira delivers comprehensive **Oracle Health (Cerner) Aetna prior authorization automation**, directly integrating with PowerChart to transform manual, fragmented workflows into efficient, digital processes.

Revenue cycle leaders and prior authorization coordinators at hospitals and health systems leveraging Oracle Health (Cerner) frequently contend with significant friction when managing Aetna prior authorizations. The challenge spans from context switching out of PowerChart to navigating multiple Aetna submission channels, leading to delays and administrative burden.

Navigating Oracle Health (Cerner) Aetna PA Challenges

For organizations using Oracle Health (Cerner) Millennium, managing Aetna prior authorizations often involves significant operational hurdles. Staff frequently face PowerChart context switching, reliance on fax-heavy workflows, and the fatigue of manually entering data into various payer portals like Availity for Aetna medical benefit requests.

Klivira's Seamless Oracle Health (Cerner) Integration

Klivira integrates directly with Oracle Health (Cerner) via **SMART on FHIR** capabilities, allowing prior authorization workflows to launch from within PowerChart. Leveraging **FHIR R4 APIs** and established **HL7 interfaces**, Klivira extracts necessary clinical data, such as ServiceRequest, Coverage, Patient, and Encounter details, directly from the EMR, minimizing manual data entry and ensuring data accuracy.

Optimizing Aetna's Diverse Submission Channels

Aetna utilizes multiple channels for prior authorization submissions. Klivira automates the submission process for medical benefit requests via the **Availity provider portal** and supports **X12 278 transactions** through clearinghouses. For pharmacy benefit requests, Klivira connects with Aetna's ePA partners, **CoverMyMeds** and **Surescripts**, streamlining retail pharmacy prior authorizations.

Automated Workflows for Aetna Medical and Pharmacy Benefits

Klivira's platform intelligently routes and prepares prior authorization requests based on Aetna's specific requirements, including those outlined in their **Clinical Policy Bulletins (CPBs)**. This includes automating the assembly of clinical documentation from Oracle Health (Cerner) for both medical procedures and specialty medications, ensuring comprehensive packets are submitted to the correct Aetna channel.

Accelerating Compliance with CMS-0057-F for Aetna

For Aetna's Medicare Advantage and Medicaid managed-care lines of business, **CMS-0057-F** introduces new requirements for electronic prior authorization and decision timeframes. Klivira's automation capabilities help health systems meet these evolving regulatory mandates by expediting submission processes and facilitating faster turnaround times, aiding compliance efforts.

Key Operational Benefits for Oracle Health (Cerner) & Aetna PA

Eliminate PowerChart context switching for Aetna PA tasks.
Automate data extraction from Cerner Millennium for Aetna submission packets.
Centralize submission and status tracking across Availity, X12 278, and ePA partners.
Reduce manual entry into Aetna's various portals and channels.
Improve data accuracy and completeness for Aetna's Clinical Policy Bulletins (CPBs).
Support compliance with CMS-0057-F requirements for impacted Aetna lines of business.

Frequently asked questions

How does Klivira integrate with Oracle Health (Cerner) for Aetna prior authorizations?

Klivira integrates with Oracle Health (Cerner) primarily through **SMART on FHIR** capabilities, allowing direct launch from PowerChart. We also leverage **FHIR R4 APIs** for comprehensive data exchange and support **HL7 v2 interfaces** to ensure compatibility with existing Cerner deployments, pulling relevant patient and order data.

Which Aetna prior authorization submission channels does Klivira support?

Klivira supports Aetna's primary medical benefit channels, including the **Availity provider portal** and **X12 278 transactions** via clearinghouses. For pharmacy benefit prior authorizations, we integrate with Aetna's ePA partners, **CoverMyMeds** and **Surescripts**, to streamline retail pharmacy requests.

Can Klivira automate prior authorizations for both Aetna medical and pharmacy benefits?

Yes, Klivira automates prior authorizations across both Aetna's medical and pharmacy benefits. Our platform intelligently identifies the correct submission channel and prepares the necessary documentation, whether it's for a medical procedure requiring Availity submission or a prescription drug managed through CoverMyMeds or Surescripts.

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

Klivira's system is designed to extract and organize clinical data from Oracle Health (Cerner) in alignment with the requirements specified in Aetna's **Clinical Policy Bulletins (CPBs)**. This ensures that submitted documentation precisely addresses Aetna's medical necessity criteria, reducing the likelihood of denials due to insufficient information.

How does Klivira address CMS-0057-F requirements for Aetna prior authorizations?

For Aetna's Medicare Advantage and Medicaid plans, which are impacted by **CMS-0057-F**, Klivira automates the electronic submission process, facilitating faster turnaround times. Our solution helps providers meet the rule's mandate for expedited decisions, contributing to overall compliance with the phased implementation timeline.