eClinicalWorks Fidelis Care Prior Authorization Automation

Klivira delivers integrated **eClinicalWorks Fidelis Care prior authorization automation**, streamlining the complex process of securing approvals for Medicaid and Medicare patients. Our platform connects directly to eCW, simplifying submission and tracking for Fidelis Care plans.

Revenue cycle leaders and prior authorization coordinators at mid-sized ambulatory practices using eClinicalWorks face unique challenges navigating Fidelis Care's specific requirements. The manual burden of submitting, tracking, and managing prior authorizations for this major New York Medicaid/Medicare payer often leads to delays and administrative overhead. Klivira addresses these operational friction points directly, integrating with eCW to automate critical PA workflows.

Streamlining Fidelis Care Prior Authorizations from eClinicalWorks

Submitting prior authorizations to Fidelis Care, a Centene-owned payer focused on Medicaid and Medicare in New York, traditionally involves navigating external portals or manual processes. For eClinicalWorks users, this often means toggling between systems, re-keying patient data, and monitoring disparate communication channels. Klivira unifies these fragmented workflows, providing a cohesive experience for PA submission and tracking directly from your eCW environment.

Klivira's Deep Integration with eClinicalWorks

eClinicalWorks FHIR R4 APIs for patient and clinical data retrieval (US Core resources).
SMART App Launch for context-aware workflows directly within eCW's clinical UI.
Integration with Healow modules for enhanced payer-side data exchange and patient engagement.
Write-back capabilities for depositing PA status updates and approved packets as DocumentReferences in eCW's Progress Notes.

End-to-End Workflow Automation for Fidelis Care

Our solution automates the full prior authorization lifecycle for Fidelis Care, from initial submission to final approval and documentation within eClinicalWorks. Klivira intelligently identifies services requiring PA, extracts necessary clinical documentation from eCW's Patient Hub and Progress Notes, and compiles comprehensive submission packets. This automation significantly reduces the manual steps involved in preparing and sending requests to Fidelis Care, whether via X12 278, ePA partners, or payer portals.

Accelerating Approvals for Key Service Lines

Given Fidelis Care's focus on Medicaid and Medicare populations in New York, timely prior authorizations are critical for specialty medications, advanced imaging, and specific surgical procedures. Klivira's platform is designed to expedite approvals for these high-volume, high-cost services. By ensuring complete and accurate submissions from eClinicalWorks, we help reduce common denial reasons and accelerate patient access to necessary care.

Operational Benefits for eClinicalWorks Practices

Integrating Klivira with eClinicalWorks for Fidelis Care prior authorizations yields tangible operational benefits. Prior authorization coordinators gain a centralized dashboard to manage all Fidelis Care requests, track statuses, and receive alerts, often surfacing within eCW's Inbox/Task Management system. This reduces time spent on phone calls and portal navigation, allowing staff to focus on patient care rather than administrative overhead.

Secure Data Exchange and Compliance Considerations

Klivira ensures all data exchange between eClinicalWorks and Fidelis Care adheres to industry standards for security and privacy. Our platform is built with HIPAA and PHI protection as a core principle, leveraging secure FHIR endpoints and robust access controls. Practices should consult with their compliance teams to ensure their overall prior authorization processes align with relevant regulations, including those outlined in CMS-0057-F related to payer interoperability.

Frequently asked questions

How does Klivira connect to eClinicalWorks for prior authorization data?

Klivira integrates with eClinicalWorks primarily through its FHIR R4 APIs, leveraging US Core resources for secure data exchange. We also support SMART App Launch to provide context-aware workflows directly within the eCW clinical UI, pulling necessary patient and clinical data for PA submissions.

Can Klivira handle different types of prior authorizations for Fidelis Care?

Yes, Klivira is designed to manage a broad spectrum of prior authorizations for Fidelis Care, including those for specialty medications, advanced imaging, durable medical equipment, and various procedures. Our system intelligently identifies the specific requirements for each service.

How does Klivira send prior authorization requests to Fidelis Care?

Klivira connects to payers like Fidelis Care through multiple channels, including direct X12 278 transactions, established ePA vendor networks, and automated interactions with payer portals. Our system intelligently routes submissions based on payer capabilities and service type.

Does Klivira write back PA status updates into eClinicalWorks?

Yes, Klivira supports write-back capabilities into eClinicalWorks. Approved prior authorization packets, status updates, and relevant payer correspondence can be deposited as DocumentReferences within eCW's Progress Notes or surfaced as tasks in the Inbox/Task Management module, ensuring a complete patient record.

Is Klivira's integration with eClinicalWorks secure and HIPAA compliant?

Klivira prioritizes the security and privacy of protected health information (PHI). Our integration with eClinicalWorks utilizes secure, encrypted channels and adheres to industry best practices and HIPAA regulations, ensuring data integrity and confidentiality throughout the prior authorization process.