Streamlining ChartLogic Specialty Drug Prior Auth

The Unique Demands of Specialty Drug PA in ChartLogic Environments

Specialty practices, the core focus of ChartLogic, frequently prescribe medications requiring prior authorization that span both medical and pharmacy benefits. Without automation, staff must manually determine the correct benefit channel, navigate disparate payer portals or ePA systems like CoverMyMeds or Surescripts, and compile extensive clinical documentation. This manual burden, compounded by payer-specific step-therapy rules and site-of-care policies, directly impacts patient access to critical therapies and revenue cycle efficiency.

Seamless Integration with ChartLogic's API for Enhanced PA Workflows

Klivira connects with ChartLogic through its robust ChartLogic API, establishing a secure, bidirectional data flow. This integration allows Klivira to automatically extract essential patient data—such as demographics, diagnoses, medication orders, and prior-line therapy history—directly from ChartLogic's patient records. By leveraging this real-time data, Klivira eliminates manual data entry, ensuring PA submissions are accurate and complete from the outset, without requiring staff to leave their established ChartLogic workflows.

Automated Specialty Drug Prior Auth Workflow Powered by ChartLogic Data

• **Automated Benefit Determination:** Klivira's policy engine analyzes ChartLogic's patient and prescription data to instantly identify whether a specialty drug falls under the medical or pharmacy benefit, routing the PA request to the correct channel automatically.
• **Multi-Channel Submission:** Pharmacy-benefit specialty drugs are routed via ePA partners like CoverMyMeds or Surescripts using the NCPDP SCRIPT standard. Medical-benefit submissions leverage X12 278, Da Vinci PAS where available, or direct payer portal connectivity.
• **Intelligent Documentation Assembly:** Klivira extracts relevant clinical notes, diagnosis codes, and medication history from ChartLogic to automatically populate step-therapy requirements and supporting documentation, reducing manual chart review.
• **Site-of-Care Optimization:** For medical-benefit specialty drugs, Klivira integrates payer site-of-care policies, flagging potential mismatches before submission and helping ChartLogic users align with payer requirements.
• **Coordinated Specialty Pharmacy Handoff:** Post-approval, Klivira streamlines the handoff to payer-preferred specialty pharmacies (e.g., Accredo, CVS Specialty, Optum Specialty), accelerating fulfillment and patient access to medication.

Addressing Common Failure Modes for ChartLogic Specialty Practices

The integration between Klivira and ChartLogic directly addresses critical points of failure in specialty drug prior authorization. Automated benefit-side determination prevents misclassification, a common cause of delays. By leveraging FHIR MedicationRequest data from ChartLogic, Klivira ensures step-therapy documentation gaps are closed. Site-of-care policy mismatches are identified proactively, and coordinated post-approval workflows mitigate specialty pharmacy fulfillment delays, ensuring patients receive their medications faster.

Adherence to Industry Interoperability Standards

Klivira's platform is built on industry-recognized standards to ensure robust and secure data exchange. For pharmacy-benefit PAs, we utilize the NCPDP SCRIPT standard, which is widely adopted for electronic prior authorization. For medical-benefit specialty drugs, Klivira leverages FHIR MedicationRequest resources for clinical data exchange and supports submissions via X12 278 and Da Vinci PAS, aligning with evolving interoperability mandates and ensuring compliance considerations are met.