eClinicalWorks Prior Authorization Automation

Klivira delivers robust eClinicalWorks prior authorization automation, integrating seamlessly with your eCW EMR to streamline workflows and accelerate patient care.

For revenue cycle directors and prior authorization coordinators at mid-sized ambulatory practices utilizing eClinicalWorks, manual PA processes can be a significant bottleneck. Klivira directly addresses this challenge by automating critical steps, from submission to status tracking, within your existing eCW environment. Our platform is engineered to enhance operational efficiency and improve turnaround times.

Deep Integration with eClinicalWorks EMR

Klivira leverages eClinicalWorks' robust integration surfaces, including the eCW API, HL7 interfaces, and FHIR endpoints, to ensure comprehensive data exchange. We utilize FHIR R4 read APIs covering US Core resources like Patient, Encounter, Coverage, and ServiceRequest (src: us-core, src: ecw-interop). This deep connectivity enables our platform to pull necessary clinical and administrative data directly from the patient chart, reducing the need for manual data entry.

Key Prior Authorization Artifacts within eClinicalWorks

**Patient Hub / Patient Dashboard:** Centralized view for patient context and status updates.
**Progress Notes / Documentation:** Storage for partner-supplied PA packets and clinical documentation.
**Orders / e-Prescribing:** Detection of PA requirements for medications and procedures at the point of order.
**Inbox / Task Management:** Workflow-task system for PA status follow-up, payer correspondence, and peer-to-peer scheduling.
**Healow Modules:** Used for patient-facing communication and specific payer-side data exchange (src: healow).

Leveraging SMART on FHIR for Seamless Workflows

Our integration with eClinicalWorks supports SMART App Launch (src: smart-app-launch), allowing Klivira to be launched directly from within the eCW clinical UI. This provides immediate patient context via standard SMART parameters, ensuring that PA workflows are initiated with all relevant data. We adhere to OAuth 2.0 scopes as per the SMART specification, facilitating secure and compliant access to necessary information.

Optimizing Payer Interoperability and CMS-0057-F Compliance

eClinicalWorks, through its Healow platform, has emphasized capabilities for payer-to-payer data exchange (src: healow), which aligns with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) (src: cms-0057-f). Klivira complements these efforts by automating the submission and tracking of prior authorizations, working within the eCW ecosystem to streamline the flow of information between providers and payers, and supporting the receipt of payer-supplied coverage and PA-policy data.

Klivira's Integration Approach with eClinicalWorks

**Automated Data Retrieval:** Pulls patient demographics, clinical notes, and order details from eCW via FHIR and HL7.
**Intelligent PA Submission:** Pre-populates X12 278 transactions or payer portal forms with extracted data.
**Status Write-back:** Updates eCW with real-time PA status, payer correspondence, and approval documents, typically as DocumentReference or Communication resources.
**Task Management Integration:** Creates and updates tasks in the eCW Inbox for follow-up actions or alerts.
**Healow Connectivity:** Integrates with Healow for patient communication relevant to PA status and information requests (src: healow).

Ensuring Compliance and Data Exchange Standards

Klivira's integration with eClinicalWorks is designed with adherence to industry standards and regulatory requirements. eClinicalWorks is listed on the ONC Certified Health IT Product List (CHPL) (src: onc-chpl), demonstrating its commitment to certified health IT. Our platform leverages these certified capabilities, including Cures Update API status and USCDI version coverage, to ensure secure and compliant exchange of ePHI during prior authorization processes.

Frequently asked questions

How does Klivira handle the distinction between core eClinicalWorks APIs and the Healow platform?

Klivira is engineered to interact with both core eCW APIs and Healow modules as needed (src: common operator quirks). Our integration strategy accounts for the differing semantics and capabilities, ensuring that data is accessed and exchanged optimally whether it resides in the core EMR or through Healow for patient engagement and payer-side interoperability.

What specific FHIR resources does Klivira utilize for prior authorization workflows within eClinicalWorks?

Klivira primarily utilizes FHIR R4 resources conforming to US Core (src: us-core) for reading patient data, including Patient, Encounter, Coverage, ServiceRequest, and MedicationRequest. For write-back capabilities, we focus on resources like DocumentReference for uploading PA packets, Communication for payer correspondence, and Task for workflow management.

Does Klivira support write-back of PA status and documents into eClinicalWorks?

Yes, Klivira supports write-back to eClinicalWorks for prior authorization-relevant information. This includes depositing approved PA documents as DocumentReference resources and updating workflow status or creating new tasks within the eCW Inbox, ensuring the patient chart remains current and complete.

How does Klivira integrate into the eClinicalWorks user interface?

Klivira integrates into the eClinicalWorks user interface via SMART App Launch (src: smart-app-launch). This allows clinicians and PA coordinators to launch Klivira directly from the eCW UI, with patient context passed automatically. This embedded workflow ensures a seamless user experience without requiring users to navigate to a separate application.

Are there differences in Klivira's integration for cloud-hosted versus self-hosted eClinicalWorks deployments?

Yes, customer-side configuration can vary between cloud-hosted and self-hosted eCW deployments (src: common operator quirks). Klivira's integration approach is designed to accommodate these differences, with specific attention to how token endpoints are discovered and how capability statements are consulted for each customer's unique environment to ensure consistent performance.