ChartLogic Anthem (Elevance Health) Prior Authorization Automation

Streamlining Prior Authorization from ChartLogic to Anthem

Specialty ambulatory practices using ChartLogic often face unique challenges when submitting prior authorizations to Anthem-licensed plans. Klivira addresses this by automating data extraction from the ChartLogic EMR and intelligently routing requests to Anthem's appropriate channels, whether it's through Availity Essentials for medical PAs, Carelon Medical Benefits Management for specialty services, or ePA partners for pharmacy benefits.

Navigating Anthem's Diverse Prior Authorization Channels

Anthem (Elevance Health) employs a multi-faceted approach to prior authorization. Medical benefit PA for commercial and Medicare Advantage plans typically routes through Availity Essentials, which also supports X12 278 transactions via clearinghouses. For specific services like advanced imaging, cardiology, MSK, sleep, and radiation oncology, submissions are directed to the Carelon Medical Benefits Management provider portal. Pharmacy PAs, managed by CarelonRx, utilize ePA partners like CoverMyMeds and Surescripts. Klivira's platform is engineered to connect with these distinct submission pathways, ensuring accurate and timely transmission of requests.

Klivira's Integration with ChartLogic EMR

Klivira establishes a direct, secure integration with ChartLogic via its API. This connectivity enables seamless extraction of patient demographics, clinical documentation, and order details directly from the EMR. By automating data transfer, Klivira eliminates manual re-entry, reduces the risk of errors, and ensures that prior authorization requests are comprehensive and consistent with the patient's record in ChartLogic.

Automating Specialty-Specific Prior Authorizations for ChartLogic Users

Given ChartLogic's focus on specialty ambulatory practices, Klivira is particularly adept at handling complex prior authorizations for services frequently subject to medical necessity review. This includes specialty injectables and infusions on the medical benefit, which may route through Carelon, as well as procedures managed by Carelon Medical Benefits Management. Klivira helps ensure that requests are aligned with Anthem's site-of-care and clinical-indication policies, drawing relevant data from ChartLogic to support medical necessity.

Accelerating Policy Adherence and Decision Times

Anthem operating companies publish medical policies and clinical utilization management guidelines through provider sites accessible via Availity, with Carelon MBM maintaining separate guidelines for its in-scope domains. Klivira's automation facilitates the submission of complete documentation, which is crucial for meeting payer criteria. For Anthem's Medicare Advantage and Medicaid plans, Klivira helps practices align with CMS-0057-F mandates, supporting the 72-hour standard and 24-hour expedited decision timeframes.

Key Benefits of Klivira for ChartLogic + Anthem PA

• Reduced manual data entry and administrative burden for PA coordinators.
• Accelerated submission of prior authorization requests to Anthem's varied channels.
• Improved adherence to Anthem's medical policies and Carelon MBM guidelines.
• Enhanced visibility and tracking of PA status from within your ChartLogic workflow.
• Support for compliance considerations related to state-specific PA regulations and CMS-0057-F.
• Minimization of denials due to incomplete documentation or incorrect submission pathways.