Enhancing Oracle Health (Cerner) Medi-Cal Prior Authorization Automation

The Challenge of Medi-Cal PA within Oracle Health (Cerner)

Healthcare providers utilizing Oracle Health (Cerner) for their acute-care operations face significant hurdles in managing Medi-Cal prior authorizations. Common pain points include extensive PowerChart context switching to access external payer portals, reliance on fax-heavy workflows, and the overall fatigue associated with manual navigation of disparate payer systems. These inefficiencies directly impact staff productivity and patient care timelines for California's Medicaid population.

Klivira's Integration with Oracle Health (Cerner) for PA Automation

• **SMART on FHIR App Launch:** Klivira integrates as a SMART App, launching directly from PowerChart to maintain patient and encounter context, minimizing context switching.
• **FHIR R4 API Connectivity:** Leverages FHIR R4 APIs for secure, standardized data exchange, including US Core resources like Coverage, ServiceRequest, MedicationRequest, Patient, and Encounter.
• **CDS Hooks for Proactive Alerts:** Utilizes CDS Hooks at order entry (`order-select`, `order-sign`) to surface Medi-Cal prior authorization requirements proactively within the clinical workflow.
• **HL7 v2 Interface Support:** Recognizes the continued operational importance of HL7 v2 interfaces for receiving admission (ADT) and order (ORM) events in many production Cerner deployments.
• **Read/Write Capabilities:** Accesses clinical documentation from Documents/Clinical Notes via FHIR DocumentReference and, where configured, writes back PA packets and status updates.

Streamlining Medi-Cal Prior Authorization Workflows

Klivira's platform automates the submission and management of prior authorizations for Medi-Cal patients directly from your Oracle Health (Cerner) EMR. This reduces the administrative burden on PA coordinators by pre-populating forms with patient data, attaching necessary clinical documentation, and routing requests through appropriate electronic channels. The goal is to accelerate approval times and decrease denial rates specific to California's Medicaid program.

Key Capabilities for Oracle Health (Cerner) and Medi-Cal

• **Automated Data Extraction:** Gathers relevant patient demographics, clinical notes, orders, and diagnoses from PowerChart to build comprehensive PA requests.
• **Intelligent Form Population:** Automatically fills out Medi-Cal-specific authorization forms, reducing manual data entry errors and accelerating submission.
• **Payer Connectivity:** Connects to Medi-Cal's electronic submission channels, facilitating efficient transmission of authorization requests.
• **Status Tracking and Alerts:** Provides real-time tracking of PA status, with updates and notifications routed to the Message Center or other configured EMR modules.
• **Documentation Management:** Supports the upload and management of supporting clinical documentation (e.g., via FHIR DocumentReference) required for Medi-Cal approvals.

Addressing Specific Medi-Cal Service Lines

Our solution is designed to handle a broad spectrum of prior authorization requirements for Medi-Cal, covering various service lines critical for hospitals and health systems. This includes medical procedures, imaging studies, surgical interventions, and specialty medications. By centralizing these diverse PA workflows, Klivira ensures consistent compliance with Medi-Cal's specific guidelines and reduces the potential for delays across all care areas.