Optimizing DrChrono Surescripts Integration for ePA Automation

Klivira streamlines the DrChrono Surescripts integration, automating prior authorizations for specialty drugs directly from your DrChrono EHR environment.

Small ambulatory and concierge practices leveraging DrChrono EHR face unique challenges in managing prior authorizations, particularly for high-cost specialty medications. Manual ePA processes are resource-intensive, leading to delays in patient care and potential revenue cycle impacts. Klivira’s platform is engineered to mitigate these issues by providing a robust, automated solution for DrChrono Surescripts integration.

Architecting the DrChrono Surescripts ePA Workflow

Klivira establishes a secure, bidirectional integration with DrChrono leveraging its native DrChrono API and FHIR endpoints. This architecture enables the seamless exchange of critical patient and prescription data required for ePA submissions via the Surescripts network. Our platform acts as an intelligent intermediary, translating DrChrono's clinical data into the structured formats necessary for efficient Surescripts ePA processing.

Data Exchange: DrChrono, Surescripts, and Klivira

For a comprehensive prior authorization submission, Klivira pulls essential clinical and demographic data directly from DrChrono. This includes patient identifiers, diagnoses (ICD-10), prescribed medications (RxNorm, NDC), and provider details. Concurrently, Klivira queries the Surescripts network and payer portals to retrieve real-time formulary information, benefit eligibility, and specific prior authorization requirements (e.g., medical necessity criteria, step therapy protocols) relevant to the prescribed drug.

Key Integration Points and Data Flows

**Patient Demographics**: Securely extracted from DrChrono via API for accurate Surescripts patient matching.
**Prescription Data**: Medication details, dosage, and SIG pulled from DrChrono’s medication module.
**Diagnosis Codes**: Relevant ICD-10 codes associated with the prescription are retrieved from DrChrono clinical templates.
**Provider Information**: NPI and contact details sourced from DrChrono for the prescribing clinician.
**Payer & Formulary Data**: Klivira aggregates real-time eligibility and formulary requirements via Surescripts and direct payer connections.
**ePA Status Updates**: Automated status checks and notifications pushed back into DrChrono’s workflow, providing visibility to PA coordinators.

Automating the Surescripts ePA Submission Process

Once all necessary data is compiled, Klivira automates the generation and submission of the prior authorization request through the Surescripts ePA platform. This process adheres to industry standards such as NCPDP SCRIPT and Da Vinci PAS, ensuring data integrity and interoperability. The automated submission drastically reduces the manual effort traditionally associated with completing and transmitting X12 278 transactions or proprietary payer forms.

Actionable Insights and Workflow Management

Beyond submission, Klivira provides a centralized dashboard for managing all prior authorizations initiated from DrChrono. This includes tracking submission status, receiving payer responses, and managing appeals for denied requests. Our platform surfaces actionable insights, allowing PA coordinators to prioritize tasks, access required documentation, and communicate effectively with prescribing providers and patients, all while maintaining a clear audit trail within the DrChrono ecosystem.

Frequently asked questions

How does Klivira handle prior authorization denials for DrChrono users?

Klivira’s platform automatically flags denied prior authorizations and provides tools for efficient appeal management. It can guide PA coordinators through the appeal process, identifying common reasons for denials and suggesting necessary documentation or clinical justifications to resubmit the request to the payer.

Is the DrChrono Surescripts integration real-time?

While the initial data pull from DrChrono is near real-time, the Surescripts ePA submission and payer response times can vary. Klivira automates the submission process and continuously monitors for status updates, pushing notifications back to your DrChrono workflow as they become available, ensuring timely communication.

What data from DrChrono is used for Surescripts ePA submissions?

Klivira utilizes key data points from DrChrono, including patient demographics, active medication lists, relevant diagnoses (ICD-10), and prescribing provider information. This ensures that all necessary clinical context is provided for a complete and accurate prior authorization request.

Does Klivira support all types of medications for DrChrono Surescripts ePA?

Klivira's integration with Surescripts is designed to support a wide range of medications requiring prior authorization, with a particular focus on specialty drugs. The platform dynamically adapts to payer-specific requirements and formulary rules to facilitate ePA for eligible prescriptions.

How does Klivira ensure HIPAA compliance with DrChrono and Surescripts data?

Klivira maintains stringent security protocols and adheres to HIPAA regulations for all PHI exchanged between DrChrono and the Surescripts network. Data is encrypted in transit and at rest, and access controls are meticulously managed to ensure privacy and security throughout the ePA workflow.