TruBridge (CPSI) Jardiance Prior Authorization Automation

Klivira optimizes the TruBridge (CPSI) Jardiance prior authorization process, ensuring timely approvals and reduced administrative burden for rural and community hospitals.

Managing prior authorizations for high-cost, high-volume medications like Jardiance (empagliflozin) within the TruBridge (CPSI) EMR environment presents unique challenges for revenue cycle directors and prior authorization coordinators. Klivira provides a targeted solution to automate the intricate workflows, from order entry to payer submission, directly integrating with your existing TruBridge infrastructure.

Jardiance Order Entry and ePA Integration within TruBridge

When a provider orders Jardiance (empagliflozin) in TruBridge (CPSI), Klivira’s integration immediately identifies the need for prior authorization. Our system leverages the TruBridge API to intercept medication orders, extract relevant patient data, and initiate the ePA process, ensuring a seamless transition from clinical decision to administrative action without manual data re-entry. This approach is critical for maintaining efficiency in the fast-paced rural and community hospital setting.

Navigating Pharmacy vs. Medical Benefit for SGLT2 Inhibitors in TruBridge

Jardiance, as an SGLT2 inhibitor, is typically covered under the pharmacy benefit. However, its indications for heart failure and chronic kidney disease can sometimes necessitate medical benefit considerations depending on payer contracts and specific care pathways. Klivira's platform is configured to discern the appropriate benefit pathway within the TruBridge context, guiding the prior authorization request to the correct channel, whether it's an NCPDP SCRIPT ePA for pharmacy or an X12 278 for medical benefit where applicable.

Key Clinical Data Points for Jardiance PA from TruBridge

Diagnosis codes (ICD-10) for type 2 diabetes, heart failure, and chronic kidney disease, pulled directly from the TruBridge problem list.
Relevant lab results, including eGFR, A1c, and serum creatinine, extracted from the patient's TruBridge chart.
Medication history demonstrating failed trials or contraindications to preferred agents like metformin, supporting step therapy requirements.
Provider notes and progress summaries offering clinical justification for Jardiance, retrieved from structured and unstructured data fields within TruBridge.
Patient demographics and insurance information for accurate payer identification and submission.

Optimizing Specialty Pharmacy Routing for Jardiance

Many SGLT2 inhibitors like Jardiance are dispensed through specialty pharmacies. Klivira's integration with TruBridge facilitates the accurate identification and routing of Jardiance prescriptions to the appropriate specialty pharmacy networks. This ensures that once prior authorization is secured, the medication fulfillment process can proceed without delays, improving patient access and reducing the administrative burden on your pharmacy and PA teams.

Klivira's Integration with TruBridge for Enhanced PA Automation

Klivira's robust integration with TruBridge (CPSI, Evident, Thrive EHR) streamlines the entire prior authorization lifecycle for Jardiance. By leveraging the TruBridge API, we automate the extraction of necessary clinical documentation, auto-populate ePA forms, and manage submission and status tracking. This direct data exchange minimizes manual effort, reduces errors, and accelerates approval times, directly impacting your revenue cycle efficiency and patient care continuity.

Frequently asked questions

How does Klivira identify if Jardiance requires a prior authorization in TruBridge?

Klivira integrates directly with TruBridge (CPSI) to monitor medication orders. Upon detecting a Jardiance order, our system cross-references it with payer-specific rules and formulary requirements to determine if a prior authorization is necessary, initiating the workflow automatically.

What specific data does Klivira pull from TruBridge for a Jardiance PA?

Klivira extracts critical data points such as ICD-10 diagnosis codes (e.g., for type 2 diabetes, heart failure, CKD), relevant lab results (e.g., eGFR, A1c), medication history for step therapy validation, and clinical notes, all directly from the patient's TruBridge chart.

Does Klivira integrate with specialty pharmacies for Jardiance prescriptions?

Yes, Klivira helps facilitate the appropriate routing of Jardiance prescriptions to specialty pharmacies. While we focus on prior authorization, our system ensures that the necessary PA approval is in place for seamless hand-off to the dispensing specialty pharmacy.

How does Klivira handle step therapy requirements for Jardiance within TruBridge?

Klivira automatically reviews the patient's medication history within TruBridge to identify if step therapy requirements, such as a trial of metformin, have been met or if contraindications exist. This evidence is then automatically included in the ePA submission to support medical necessity.

Is Jardiance typically a pharmacy or medical benefit drug when ordered via TruBridge?

Jardiance (empagliflozin) is predominantly covered under the pharmacy benefit. Klivira's platform is designed to process these through NCPDP SCRIPT ePA. However, for specific indications or payer contracts, some aspects might touch upon medical benefit considerations, which our system is equipped to identify and manage.