Seamless Oracle Health (Cerner) Highmark Prior Authorization Automation

Klivira delivers comprehensive Oracle Health (Cerner) Highmark prior authorization automation, directly integrating with your EMR to streamline submissions and accelerate approvals.

Revenue cycle directors and prior authorization coordinators often face significant operational overhead managing prior authorizations for Highmark members from within Oracle Health (Cerner). The manual steps, context switching between PowerChart and payer portals like Availity, and tracking diverse state-specific requirements drain staff resources and delay patient care. Klivira addresses these challenges by automating the entire lifecycle.

Optimizing Prior Authorization Workflows within Oracle Health (Cerner)

Oracle Health (Cerner) users, particularly those in hospitals and health systems, frequently encounter inefficiencies when managing prior authorizations. The need to navigate away from PowerChart, deal with fax-heavy processes, and engage in constant payer portal fatigue for Highmark requests significantly impacts productivity. Klivira directly integrates with your Oracle Health (Cerner) EMR to embed PA workflows at the point of care.

Key Integration Capabilities with Oracle Health (Cerner)

**SMART on FHIR App Launch:** Securely launch Klivira's application directly from PowerChart, maintaining patient and encounter context.
**FHIR R4 API Connectivity:** Leverage FHIR R4 APIs to extract critical patient data, including Coverage, ServiceRequest, and MedicationRequest, and support write-back of PA status and documentation where EMR configuration allows.
**CDS Hooks for Order Entry:** Proactively identify Highmark PA requirements at the point of order entry within PowerChart, preventing delays before they occur.
**HL7 v2 Interface Support:** Complement FHIR-based integrations with robust HL7 v2 interfaces for ADT, ORM, and other critical event streams in existing Cerner deployments.
**Unified Documentation:** Automate the assembly and submission of clinical documentation for Highmark, writing back critical PA artifacts to the Documents/Clinical Notes section.

Seamless Connectivity to Highmark for Prior Authorization

Klivira provides direct, automated channels to Highmark for prior authorization submissions. For medical benefit PAs, our platform connects through established pathways like Availity Essentials and supports X12 278 transactions via clearinghouses. This ensures that authorizations for Highmark members in Pennsylvania, West Virginia, Delaware, and New York are routed efficiently according to state-specific requirements.

Comprehensive Prior Authorization Automation for Highmark Members

Our solution automates the entire prior authorization lifecycle for Highmark members. From initial PA detection triggered by a CDS Hook at order entry in Oracle Health (Cerner), Klivira intelligently extracts necessary clinical data, populates Highmark-specific forms, and submits the request through the appropriate channel. The platform then tracks the status, manages communications, and writes updates directly back into PowerChart's Message Center, eliminating manual follow-up.

Navigating Highmark's Diverse Utilization Management Policies

Highmark's utilization management policies, including those for advanced imaging, specialty drugs, and surgical procedures, are dynamically incorporated into Klivira's automation engine. We help identify and adhere to specific requirements, including those routed through specialty benefit management vendors, and account for CMS-0057-F mandates impacting Highmark's Medicare Advantage, Medicaid managed care, and QHP-on-FFM lines. This ensures compliance and reduces denials.

Frequently asked questions

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

Klivira integrates with Oracle Health (Cerner) via SMART on FHIR for app launch and context, FHIR R4 APIs for data exchange, and CDS Hooks to detect PA requirements at order entry. We also support HL7 v2 interfaces for comprehensive connectivity in existing deployments, embedding PA workflows directly within PowerChart.

Which Highmark prior authorization submission channels does Klivira support?

Klivira automates submissions to Highmark primarily through Availity Essentials for medical benefit prior authorizations. We also support X12 278 transactions via clearinghouses, ensuring that your requests are routed through Highmark's preferred electronic channels for commercial and Medicare Advantage plans.

Can Klivira help with prior authorizations for specific services or drug classes requiring Highmark approval?

Yes, Klivira is designed to handle a broad range of medical and pharmacy prior authorizations for Highmark. This includes complex cases like advanced imaging, specialty medications, and specific surgical procedures, by integrating Highmark's utilization management policies and connecting to relevant submission channels, including those for specialty benefit management vendors.

How does Klivira reduce context switching for our prior authorization team working with Oracle Health (Cerner) and Highmark?

Klivira significantly reduces context switching by embedding the prior authorization workflow directly within Oracle Health (Cerner)'s PowerChart. This allows PA coordinators to initiate, manage, and track Highmark authorizations without leaving the EMR, eliminating the need to log into separate payer portals like Availity or manage fax-based processes.

Does Klivira account for Highmark's state-specific prior authorization rules and turnaround times?

Yes, Klivira's platform is configured to account for Highmark's state-specific prior authorization requirements across Pennsylvania, West Virginia, Delaware, and New York. This includes adherence to diverse state-mandated turnaround times and compliance with federal mandates such as CMS-0057-F for applicable Highmark plans.