Streamlining CureMD UnitedHealthcare Prior Authorization Automation

The Challenge of UnitedHealthcare PA from CureMD

Ambulatory specialty practices using CureMD frequently encounter UnitedHealthcare's varied prior authorization requirements across commercial, Medicare Advantage, and Community Plan lines. Submitting medical benefit PAs often requires navigating the UHCprovider.com portal, while pharmacy benefits route through OptumRx or ePA partners like CoverMyMeds and Surescripts. This multi-channel approach, when managed manually from CureMD, creates significant administrative burden and increases the risk of inconsistent documentation.

Klivira's Integration with CureMD for UHC Workflows

Klivira connects directly to your CureMD EHR via the CureMD API, enabling a seamless prior authorization workflow without leaving the EMR environment. This integration streamlines the initiation, submission, and tracking of UnitedHealthcare prior authorizations, pulling necessary clinical data directly from the patient chart. By centralizing PA management, Klivira helps reduce manual data entry and improves the accuracy of submissions to UHC.

Navigating UnitedHealthcare's Diverse PA Channels

• **Medical Benefit Prior Auth:** Klivira automates submissions to the UnitedHealthcare Provider Portal (uhcprovider.com) and supports X12 278 transactions via clearinghouses for eligible procedures.
• **Pharmacy Benefit Prior Auth:** For pharmacy benefits, Klivira integrates with OptumRx's provider PA system, as well as ePA platforms like CoverMyMeds and Surescripts, covering prescriber-initiated workflows.
• **Specialty Drug Prior Auth:** We help manage the complex split between medical and pharmacy benefits for specialty injectables and infusions, often involving OptumRx and specific site-of-care policies.
• **Inpatient Admission Notification:** Klivira supports the advance notification and concurrent review processes for inpatient admissions, aligning with UHC's documented requirements.
• **Utilization Management Policy Access:** Our platform references UnitedHealthcare's Medical Policy Library, including criteria based on MCG or NCCN compendium, to inform PA submissions.

Optimizing Specialty Workflows and Compliance

For CureMD users in specialties such as oncology, orthopedics, or advanced imaging, Klivira helps manage UnitedHealthcare's specific medical necessity criteria and coverage rules. This includes supporting submissions for high-cost categories like genetic testing or biologics, where detailed clinical documentation and adherence to specific policies are critical. Furthermore, Klivira's automation supports compliance considerations for UHC's Medicare Advantage and Community Plan lines, which are impacted by CMS-0057-F requirements for electronic PA API conformance and decision timeframes, alongside state-mandated minimums and NCQA UM accreditation standards.

Klivira's Commitment to Interoperability Standards

UnitedHealthcare is a public participant in the HL7 Da Vinci Project, advocating for interoperability standards like Da Vinci PAS (Prior Authorization Support) IG. Klivira aligns with the industry's move towards electronic PA standards, providing a platform that can adapt to evolving requirements for medical benefit ePA and leveraging existing ePA channels for pharmacy benefits through OptumRx and its partners. This forward-looking approach ensures your CureMD practice is prepared for future interoperability mandates.