Optimizing DrChrono Aetna Prior Authorization Automation

Klivira delivers integrated DrChrono Aetna prior authorization automation, empowering small ambulatory and concierge practices to navigate Aetna's diverse submission requirements with precision and speed.

Managing prior authorizations for Aetna patients from within DrChrono presents unique challenges, from disparate submission portals to complex medical necessity criteria. Revenue cycle directors and prior authorization coordinators require a solution that reduces manual effort and improves decision turnaround, directly impacting patient care and practice profitability.

Bridging DrChrono and Aetna's Prior Authorization Ecosystem

For DrChrono's iPad-first ambulatory and concierge practices, the manual submission of prior authorizations to a national payer like Aetna can be a significant bottleneck. Klivira understands the need for seamless data flow and automated workflows to mitigate administrative burden and ensure timely patient care.

Klivira's Integration with DrChrono

Klivira integrates directly with DrChrono, leveraging the DrChrono API and FHIR endpoints to embed prior authorization workflows within your existing EHR environment. This direct connection facilitates efficient data exchange, minimizing manual data entry and reducing the potential for errors when initiating Aetna prior authorizations.

Navigating Aetna's Diverse Submission Channels

Aetna employs multiple channels for prior authorization submissions. Medical benefit requests often route through the Availity provider portal or via X12 278 transactions through clearinghouses. Pharmacy benefit prior authorizations, administered by CVS Caremark, typically utilize ePA partners like CoverMyMeds or Surescripts. Klivira's platform connects to these critical pathways, streamlining submissions regardless of the benefit category.

Accessing Aetna's Medical Necessity Criteria

Aetna's Clinical Policy Bulletins (CPBs) are the definitive source for medical necessity criteria, covering a wide range of services from advanced imaging to specialty biologics. Klivira helps interpret and apply these CPB requirements during the prior authorization process, ensuring submissions are complete and aligned with Aetna's published policies to reduce denials.

Impact of Regulatory Timelines on Aetna PAs

Aetna's prior authorization turnaround times are influenced by state insurance regulations for commercial plans and CMS-0057-F for Medicare Advantage, Medicaid managed-care, CHIP, and QHP lines of business. For these impacted lines, CMS-0057-F mandates 72-hour decisions for standard requests and 24 hours for expedited requests. Klivira's automation helps practices meet these critical deadlines, improving efficiency and patient access.

Streamlining Key Aetna PA Workflows from DrChrono

Automating medical-benefit procedure requests via Availity or X12 278.
Facilitating pharmacy-benefit medication authorizations through ePA partners.
Managing specialty drug authorizations, accounting for medical vs. pharmacy benefit splits.
Ensuring documentation aligns with Aetna CPBs for medical necessity, including for advanced imaging and surgical procedures.
Tracking and managing appeal pathways for denied Aetna prior authorizations.

Frequently asked questions

How does Klivira integrate with DrChrono for prior authorizations?

Klivira integrates with DrChrono through its robust API and FHIR endpoints. This allows for direct data exchange, embedding prior authorization workflows within the EHR and minimizing manual data entry for Aetna requests.

Which Aetna prior authorization types does Klivira support?

Klivira supports a broad range of Aetna prior authorization types, including those for medical benefits submitted via Availity or X12 278, and pharmacy benefits routed through ePA partners like CoverMyMeds or Surescripts, as well as specialty drug authorizations.

Does Klivira help with Aetna's Availity portal submissions?

Yes, Klivira's platform is designed to streamline submissions that typically route through Aetna's primary multi-payer provider workspace, Availity. Our automation reduces the manual steps required to initiate and track prior authorizations for medical services.

How does Klivira address Aetna's medical necessity criteria?

Klivira helps practices align their submissions with Aetna's Clinical Policy Bulletins (CPBs). By providing visibility into these criteria, our platform assists in ensuring that all necessary documentation is included, which can reduce denials related to medical necessity.

Is Klivira compliant with CMS-0057-F for Aetna Medicare Advantage plans?

Klivira helps practices meet the requirements set by CMS-0057-F for impacted Aetna lines of business, such as Medicare Advantage. Our automation features assist in streamlining the electronic prior authorization process to support mandated turnaround times.