Streamlining Cliniko Anthem (Elevance Health) Prior Authorization Automation

Klivira provides comprehensive Cliniko Anthem (Elevance Health) prior authorization automation, specifically designed to meet the unique needs of allied health practices.

Allied health practitioners utilizing Cliniko face significant administrative burdens when seeking prior authorizations from Anthem-licensed plans. The complexity of navigating multiple submission channels and varying policy requirements can impede patient access to care and strain revenue cycle operations.

The Multi-Channel Challenge of Anthem Prior Authorizations

Anthem-licensed plans, part of Elevance Health, mandate prior authorization submissions across several distinct channels. Medical benefit PAs for commercial and Medicare Advantage lines are primarily routed through Availity Essentials, which also facilitates inpatient admission notifications. Pharmacy benefit PAs are managed via CarelonRx and ePA partners like CoverMyMeds and Surescripts.

Specialty Prior Authorization for Allied Health Services via Carelon MBM

For services frequently encountered in allied health, such as advanced imaging and musculoskeletal (MSK) procedures, Anthem utilizes Carelon Medical Benefits Management (Carelon MBM), Elevance Health's specialty-benefit-management vendor. These specific domains require submission through Carelon MBM's dedicated provider portal, operating independently from the standard medical PA channels.

Klivira's Direct Integration with Cliniko via API

Klivira automates prior authorization workflows by integrating directly with Cliniko through its robust API. This enables allied health providers to initiate, submit, and track prior authorizations seamlessly from within their familiar Cliniko practice management environment, eliminating redundant data entry and manual portal navigation.

Optimizing Prior Authorization Workflows for Cliniko and Anthem (Elevance Health)

Klivira centralizes the intricate process of submitting prior authorizations to Anthem. Our platform intelligently routes requests to the appropriate channel—whether it's Availity for general medical PAs, Carelon MBM for specialty services like imaging or MSK, or ePA partners for pharmacy benefits—based on the specific service, benefit, and payer requirements. This ensures accurate and compliant submissions.

Key Benefits for Allied Health Practices Using Cliniko with Klivira for Anthem PAs

Automated submission across Availity, Carelon MBM, and ePA partners.
Real-time status tracking and alerts integrated within Cliniko workflows.
Streamlined access to Anthem medical policies and Carelon MBM clinical guidelines.
Reduced administrative burden and operational costs for prior authorization management.
Improved turnaround times and reduced denials for critical allied health services.
Enhanced visibility into denial patterns and facilitated appeal pathways.

Frequently asked questions

How does Klivira handle different Anthem submission portals like Availity and Carelon MBM?

Klivira's platform intelligently identifies and routes each Anthem prior authorization request to the correct submission channel. For medical benefit PAs, we route through Availity Essentials, while specialized services like advanced imaging or MSK are directed to the Carelon Medical Benefits Management provider portal, ensuring compliance with Anthem's specific requirements.

Can Klivira assist with pharmacy prior authorizations for Anthem plans?

Yes, for pharmacy benefit prior authorizations with Anthem-licensed plans, Klivira supports submissions through CarelonRx's provider system and integrates with ePA partners such as CoverMyMeds and Surescripts. This ensures comprehensive coverage for both medical and pharmacy benefit prior authorizations.

What about access to Anthem (Elevance Health) prior authorization policies and guidelines?

Klivira provides access to relevant Anthem medical policies and clinical utilization management guidelines through our platform. For procedures routed through Carelon Medical Benefits Management (e.g., imaging, MSK), the specific clinical guidelines are sourced from the Carelon MBM provider site, separate from the general Anthem medical policy library.

Does Klivira support Cliniko's allied health focus for Anthem prior authorizations?

Absolutely. Klivira's integration with the Cliniko API is specifically designed to support the unique prior authorization needs of allied health practices, including physical therapy, occupational therapy, and chiropractic services. We streamline the process for obtaining approvals from Anthem for these specialized procedures.

How does Klivira address state-specific Anthem PA requirements and turnaround times?

Anthem-licensed plans operate under state-specific regulations for commercial prior authorization turnaround times, and Medicare Advantage/Medicaid plans are subject to CMS-0057-F. Klivira's system is configured to account for these variations, helping practices manage expectations and track compliance with applicable state and federal mandates.