eClinicalWorks Anthem BCBS Georgia Prior Authorization Automation

Klivira delivers comprehensive eClinicalWorks Anthem BCBS Georgia prior authorization automation, directly addressing the complexities of payer requirements and EMR workflows.

For revenue cycle directors and prior authorization coordinators utilizing eClinicalWorks (eCW), navigating Anthem BCBS Georgia's diverse PA submission channels can be a significant operational bottleneck. Manual data entry, portal hopping, and fragmented communication slow down care delivery and impact financial performance. Klivira provides a unified solution to automate these critical processes.

Bridging eClinicalWorks Workflows with Anthem BCBS Georgia Prior Authorization

The intersection of eClinicalWorks' robust ambulatory EHR capabilities and Anthem BCBS Georgia's specific prior authorization requirements demands a precise automation strategy. Our platform is engineered to extract necessary clinical data from eCW and intelligently route PA requests through Anthem GA's designated channels, eliminating manual re-keying and accelerating approval cycles.

Klivira's Deep Integration with eClinicalWorks

Klivira integrates directly with eClinicalWorks using its core APIs, including FHIR R4 read APIs for US Core resources, as well as SMART App Launch. This allows for secure, context-aware data extraction from patient charts, orders, and documentation within eCW. We leverage resources like Patient, Encounter, Coverage, ServiceRequest, and MedicationRequest to build comprehensive PA packets automatically, ensuring data accuracy and completeness.

Streamlined Submission to Anthem BCBS Georgia Channels

Anthem BCBS Georgia, an Elevance Health plan, primarily utilizes Availity Essentials for medical prior authorization submissions. For specialized services, Carelon Medical Benefits Management handles advanced imaging, cardiology, musculoskeletal, and radiation oncology reviews, while CarelonRx manages pharmacy benefits. Klivira intelligently directs prior authorization requests to the correct channel, whether it's Availity, Carelon MBM, or CarelonRx, ensuring compliance with Anthem GA's specific routing protocols.

Automating Complex Prior Authorization Scenarios

**Imaging Services:** Automated routing and submission for advanced imaging (e.g., MRI, CT) requiring review by Carelon Medical Benefits Management.
**Specialty Medications:** Streamlined electronic prior authorization (ePA) for high-cost or specialty drugs managed by CarelonRx.
**Surgical Procedures:** Efficient submission of medical necessity documentation for elective and non-emergent surgical PAs.
**Medical Necessity Reviews:** Automated compilation of clinical documentation for various services requiring medical necessity determination.
**Georgia Medicaid Managed Care:** Support for PA workflows under Anthem BCBS Georgia's contracts with the Georgia Department of Community Health, aligning with CMS-0057-F considerations.

Enhancing Efficiency and Data Integrity Across Your Revenue Cycle

By automating the prior authorization process between eClinicalWorks and Anthem BCBS Georgia, Klivira reduces administrative burden, minimizes human error, and frees up PA coordinators for higher-value tasks. This leads to faster turnaround times, fewer denials due to incomplete submissions, and improved financial outcomes for mid-sized ambulatory practices using eCW. We also support considerations for CMS-0057-F requirements for impacted lines of business.

Real-time Status Updates and EMR Write-back

Klivira not only automates submissions but also tracks the status of prior authorizations in real-time. Approved, denied, or pending statuses are communicated back to eClinicalWorks via FHIR write-back capabilities, updating relevant patient records. This includes depositing PA packets as DocumentReference entries and updating workflow tasks (eCW Inbox) or Communication logs within the Patient Hub, ensuring clinical and administrative staff have immediate access to the latest authorization information.

Frequently asked questions

How does Klivira handle PA submissions to Anthem BCBS Georgia from eClinicalWorks?

Klivira extracts relevant clinical and patient data from eClinicalWorks using FHIR APIs and SMART App Launch. It then intelligently routes and submits the prior authorization request to the appropriate Anthem BCBS Georgia channel, such as Availity Essentials for general medical services, Carelon Medical Benefits Management for specific imaging or procedures, or CarelonRx for pharmacy benefits.

What eClinicalWorks data does Klivira use for prior authorizations?

Klivira utilizes a comprehensive set of data from eClinicalWorks, including patient demographics, encounter details, coverage information, service requests, medication requests, and clinical documentation. This data is pulled via eCW's FHIR R4 US Core APIs to construct complete and accurate prior authorization submissions.

Does Klivira integrate with Availity for Anthem BCBS Georgia?

Yes, Klivira integrates with Availity Essentials, which is the primary portal for many Anthem BCBS Georgia prior authorization submissions. Our platform automates the submission process through Availity, reducing the need for manual data entry and portal navigation by your staff.

Can Klivira automate prior authorizations for services managed by Carelon Medical Benefits Management?

Absolutely. Klivira is configured to recognize services that fall under Carelon Medical Benefits Management's review scope for Anthem BCBS Georgia, such as advanced imaging or certain cardiology procedures. Our system ensures these specific PA requests are routed and submitted correctly to Carelon MBM for review.

How does Klivira update eClinicalWorks with prior authorization status?

Klivira leverages eClinicalWorks' FHIR write-back capabilities to update the EMR with the latest prior authorization status. This can include depositing the authorization letter or denial as a DocumentReference, updating a Communication resource, or creating a Task in the eCW Inbox for follow-up, ensuring the information is accessible within the patient's chart.