Streamlining eClinicalWorks Prior Authorization for Infectious Disease

For infectious disease practices utilizing eClinicalWorks, managing prior authorization for high-cost therapies can be a significant administrative burden. Klivira automates the eClinicalWorks prior authorization for infectious disease workflows, integrating directly into your existing EMR environment.

Infectious disease (ID) specialists frequently prescribe medications and therapies that necessitate prior authorization, including complex antiviral regimens, antifungals, and Outpatient Parenteral Antibiotic Therapy (OPAT). For mid-sized ambulatory practices leveraging eClinicalWorks, manual PA processes can delay critical treatment and strain revenue cycle operations. Klivira provides a purpose-built solution to integrate and automate these workflows.

The Challenge of Infectious Disease Prior Auth in eClinicalWorks

Infectious disease prior authorization often involves high-volume categories such as antivirals (e.g., for HCV, HIV), antifungals, and OPAT, each with specific payer requirements. Within eClinicalWorks, these PA requirements typically surface during order entry in the Orders / e-Prescribing module, requiring staff to navigate external payer portals or manual submission processes, which can lead to delays in patient care and increased administrative costs.

Klivira's Integrated Prior Authorization for eClinicalWorks ID Workflows

Klivira connects directly with eClinicalWorks to embed prior authorization automation within the clinical and administrative workflows ID practices already use. Our solution leverages eClinicalWorks' core APIs and FHIR endpoints, allowing for seamless data exchange without disrupting the established user experience. This integration helps accelerate approval times for critical infectious disease therapies.

Key Integration Points with eClinicalWorks for ID Prior Authorization

**Data Extraction**: Klivira utilizes eClinicalWorks FHIR R4 read APIs (US Core) to pull relevant patient, encounter, coverage, and medication request data directly from the EMR, including resources like Patient, Coverage, and MedicationRequest.
**SMART App Launch**: Our application can launch directly from the eCW clinical UI via SMART App Launch, providing patient context to streamline the PA initiation process for ID specialists.
**PA Status Write-back**: Klivira uses eCW's write-back capabilities for resources such as DocumentReference and Task, depositing PA status updates, approval documents, and follow-up tasks directly into the Patient Hub and Inbox / Task Management modules.
**Order Entry Integration**: Prior authorization detection workflows for ID medications are integrated into eCW's Orders / e-Prescribing module, identifying PA requirements at the point of care.
**Interoperability Initiatives**: Klivira integrates with eCW's ecosystem, including surfaces that support payer-side data exchange and interoperability initiatives like those outlined in CMS-0057-F, to enhance PA data flow.

Automating High-Volume ID Prior Authorization Categories

Klivira is specifically designed to manage the prior authorization complexities of high-cost infectious disease treatments. By automating the submission and tracking for categories like antivirals (HCV, HIV), antifungals, and OPAT, we reduce the manual burden on your staff. This ensures that necessary documentation is gathered efficiently from eCW and submitted to payers, minimizing delays for patients requiring timely ID interventions.

Operational Impact for eClinicalWorks ID Practices

By integrating Klivira, eClinicalWorks users in infectious disease can expect improved operational efficiency and reduced denial rates related to prior authorization. The automation of routine PA tasks frees up prior authorization coordinators to focus on complex cases, while clinical staff benefit from immediate visibility into PA status within the eCW Patient Hub, accelerating treatment initiation and improving patient outcomes.

Frequently asked questions

How does Klivira access patient data from eClinicalWorks for prior authorization?

Klivira leverages eClinicalWorks' robust FHIR R4 read APIs, which conform to US Core standards, to securely access relevant patient data. This includes information from Patient, Coverage, ServiceRequest, and MedicationRequest resources, ensuring all necessary clinical context for prior authorization is available without manual data entry.

Can Klivira launch directly from the eClinicalWorks EMR?

Yes, Klivira supports SMART App Launch from within the eClinicalWorks clinical user interface. This allows clinicians to initiate a prior authorization request directly from a patient's chart, with the patient's context automatically passed to the Klivira application, streamlining the workflow for infectious disease specialists.

How does Klivira update eClinicalWorks with prior authorization status?

Klivira utilizes eClinicalWorks' write-back capabilities for relevant FHIR resources. This means that prior authorization status updates, approval documents, and any follow-up tasks are automatically posted back into the eCW Patient Hub, Progress Notes, or Inbox / Task Management modules, providing a comprehensive audit trail and real-time visibility.

What specific infectious disease treatments benefit most from Klivira's automation with eCW?

Klivira's automation is particularly beneficial for high-volume and high-cost infectious disease treatments that frequently require prior authorization. This includes complex antiviral regimens (e.g., for HCV, HIV), various antifungals, and Outpatient Parenteral Antibiotic Therapy (OPAT), where timely approvals are critical for patient care.

Does Klivira integrate with eClinicalWorks' Healow platform for payer data exchange?

Klivira integrates with eClinicalWorks' broader ecosystem, which includes surfaces that support payer-side data exchange and interoperability initiatives, such as those that Healow facilitates. This ensures that Klivira's PA automation can leverage available data flows to optimize the prior authorization process for ID practices.