Automating Prior Authorization with DrChrono MCG Criteria Integration

Klivira automates prior authorization workflows for DrChrono users, directly integrating with DrChrono to apply and validate against DrChrono MCG criteria requirements.

For small ambulatory and concierge practices leveraging DrChrono, manual prior authorization processes, particularly those involving MCG criteria, consume significant staff time and often lead to avoidable delays or denials. Klivira provides a purpose-built solution to integrate and automate these critical steps, enhancing operational efficiency and financial outcomes.

The Challenge of Manual MCG Review in DrChrono Workflows

Practices using DrChrono frequently encounter the burden of manually reviewing MCG Health criteria for medical necessity determinations. This often involves navigating disparate systems, extracting clinical data from DrChrono's charting and order entry modules, and then cross-referencing it against payer-specific MCG guidelines, a process prone to human error and inefficiency.

Klivira's Integration with DrChrono for MCG Criteria Automation

Klivira leverages DrChrono's robust API and FHIR endpoints to establish a seamless connection. This integration allows for the secure, real-time extraction of necessary clinical data directly from DrChrono EHR, enabling automated validation against MCG criteria without manual data entry or context switching for prior authorization coordinators.

DrChrono Data Points Leveraged for MCG Criteria

Patient demographics and insurance information from the Patient Chart.
Diagnoses (ICD-10 codes) from the Problem List and Encounter Notes.
Proposed procedures (CPT/HCPCS codes) from Order Entry and Clinical Templates.
Relevant clinical documentation, including progress notes and lab results.
Medication history and allergy information.

Streamlining MCG Review Workflows within DrChrono

When a service requiring prior authorization is ordered within DrChrono, Klivira's integration acts as an intelligent layer. It automatically pulls relevant patient and clinical data, performs initial checks against known MCG criteria (as dictated by the payer), and proactively identifies potential gaps or missing documentation. This occurs in the background, minimizing disruption to the provider's workflow within DrChrono's iPad-first interface.

Beyond DrChrono: Payer-Side Data and Real-Time MCG Checks

While DrChrono provides the foundational clinical data, Klivira extends its capabilities by integrating with payer portals and utilizing X12 278 transactions. This allows Klivira to retrieve the exact MCG criteria version and specific medical necessity rules enforced by the patient's insurer, ensuring that authorizations are submitted against the most current and accurate guidelines, significantly reducing denial rates.

Key Benefits for DrChrono Users

Reduced administrative burden on prior authorization coordinators.
Accelerated turnaround times for prior authorization approvals.
Improved accuracy of submissions, leading to fewer denials.
Enhanced visibility into authorization status directly from a unified platform.
Optimized revenue cycle management through efficient PA processes.

Frequently asked questions

How does Klivira access clinical data from DrChrono for MCG criteria review?

Klivira integrates with DrChrono using its secure API and FHIR endpoints. This allows for the automated, compliant extraction of necessary patient demographics, diagnoses, procedures, and clinical notes directly from DrChrono EHR, ensuring data accuracy for MCG criteria validation.

Does Klivira integrate directly with MCG Health's platform?

Klivira does not directly integrate with MCG Health's platform. Instead, Klivira focuses on integrating with payer portals and leveraging X12 278 to access the specific MCG criteria adopted and enforced by individual payers for medical necessity determinations, ensuring alignment with actual authorization requirements.

What DrChrono modules are involved in this integration?

The integration primarily involves data extraction from DrChrono's Patient Chart, Problem List, Order Entry, and Clinical Templates. Klivira pulls information such as patient demographics, ICD-10 codes, CPT/HCPCS codes, and relevant clinical documentation to support MCG criteria review.

How does this solution impact prior authorization turnaround times for DrChrono users?

By automating data extraction from DrChrono and performing pre-submission validation against payer-specific MCG criteria, Klivira significantly reduces the manual effort and time required for prior authorization. This leads to faster, more accurate submissions and, consequently, quicker approval turnaround times.

Is the data exchange between DrChrono and Klivira HIPAA compliant?

Yes, all data exchange between DrChrono and Klivira is conducted via secure, encrypted channels and adheres to HIPAA regulations. Klivira is designed with robust security protocols to protect ePHI throughout the prior authorization workflow.