Streamlining DrChrono BCBS New York Prior Authorization Automation

For DrChrono users navigating prior authorizations with BCBS New York, the manual burden can impact patient care and revenue cycles. Klivira provides a solution for DrChrono BCBS New York prior authorization automation.

Ambulatory and concierge practices leveraging DrChrono often face unique challenges in managing prior authorizations, particularly with complex regional payers like BCBS New York. The process involves multiple portals, varying submission methods, and a constant need to track policy updates. Klivira integrates directly to streamline these workflows.

The Challenge: Manual Prior Authorizations with DrChrono and BCBS New York

Many DrChrono users experience friction when initiating and tracking prior authorizations for BCBS New York plans. This often involves manual data entry into the Availity Essentials portal for medical PAs, or navigating separate processes for services managed by Carelon Medical Benefits Management and pharmacy benefits through CarelonRx. This fragmented approach consumes staff time and can lead to delays or denials.

Navigating BCBS New York Prior Authorization Channels

BCBS New York plans, including Empire BlueCross BlueShield, utilize several distinct channels for prior authorization submissions. Medical PAs for commercial and Medicare Advantage plans are primarily routed through Availity Essentials. For specialized services such as advanced imaging, cardiology, and musculoskeletal care, submissions are managed by Carelon Medical Benefits Management. Pharmacy PAs are processed via CarelonRx, the Elevance PBM. Klivira's platform connects to these varied channels, including X12 278 transactions via clearinghouses, to centralize the submission process.

Klivira's Integration with DrChrono

Klivira integrates with DrChrono through its robust DrChrono API and available FHIR endpoints. This connectivity allows for the seamless extraction of necessary clinical data and patient demographics directly from the EHR. By leveraging these integration surfaces, Klivira minimizes manual data entry, ensuring that prior authorization requests are accurately populated and submitted from within the DrChrono workflow, enhancing efficiency for small ambulatory and concierge practices.

Optimizing Specific Workflows for DrChrono and BCBS New York

The combination of DrChrono's focus on ambulatory settings and BCBS New York's specific PA requirements means workflows for services like advanced imaging, specialty medications (e.g., biologics, GLP-1s), and certain surgical procedures are critical. Klivira automates the routing of these requests through the correct channels, whether it's Availity, Carelon Medical Benefits Management, or CarelonRx. This ensures compliance with New York insurance regulations and CMS-0057-F for applicable plans, reducing the administrative burden on your team.

Key Benefits of Automation for DrChrono and BCBS New York

Automated data extraction from DrChrono via API and FHIR endpoints.
Centralized submission to BCBS New York channels including Availity, Carelon Medical Benefits Management, and CarelonRx.
Real-time status tracking for medical and pharmacy prior authorizations.
Reduced manual administrative tasks and potential for human error.
Improved compliance with New York state and federal PA regulations.
Faster turnaround times for prior authorization approvals.

Accessing BCBS New York Policy Information

Understanding and adhering to payer-specific policies is paramount. Empire BlueCross BlueShield publishes its medical policies through its provider site, aligning with the broader Elevance corporate Utilization Management framework, but with New York-specific variations. Klivira's platform helps your team quickly access relevant policy information, ensuring that submissions meet current medical necessity criteria and documentation requirements, minimizing the risk of denials.

Frequently asked questions

How does Klivira connect with DrChrono for prior authorizations?

Klivira integrates with DrChrono using its robust DrChrono API and available FHIR endpoints. This allows for secure, automated extraction of patient demographics and clinical data directly from your EHR, populating prior authorization requests without manual entry.

Which BCBS New York plans are covered by Klivira's automation?

Klivira supports prior authorization automation for various BCBS New York plans, including commercial, Medicare Advantage, and New York Medicaid managed care plans operated by Empire BlueCross BlueShield. This includes routing to Availity Essentials, Carelon Medical Benefits Management, and CarelonRx where applicable.

How are pharmacy prior authorizations handled for BCBS New York?

For BCBS New York plans, pharmacy prior authorizations are routed through CarelonRx, the in-house Elevance PBM. Klivira automates the submission process to CarelonRx, streamlining the ePA workflow for specialty drugs and other medications requiring approval.

Does Klivira help with prior authorizations for advanced imaging or specialty procedures?

Yes, for BCBS New York, advanced imaging, cardiology, and musculoskeletal services often require prior authorization through Carelon Medical Benefits Management (formerly AIM Specialty Health). Klivira automates the submission and tracking of these specific requests, ensuring they are routed correctly.

What kind of data does Klivira extract from DrChrono for PA requests?

Klivira extracts essential clinical data, patient demographics, diagnosis codes (ICD-10), procedure codes (CPT/HCPCS), and other relevant information required for prior authorization requests, directly from your DrChrono EHR via API and FHIR endpoints.