Streamlining eClinicalWorks Prior Authorization for OB/GYN

Seamless Integration with eClinicalWorks for OB/GYN Prior Authorizations

Klivira leverages eClinicalWorks' robust integration surfaces, including its FHIR R4 APIs and SMART App Launch capabilities, to embed prior authorization workflows directly into the OB/GYN clinical context. This allows for the automatic detection of PA requirements at the point of order entry and provides patient-specific context when launching the Klivira application from within the eCW clinical UI.

Addressing High-Volume OB/GYN PA Categories within eCW

• **Fertility / IVF**: Navigating highly variable payer policies for diagnostic workup, IUI, and IVF, ensuring accurate benefit verification and submission.
• **LARC Devices**: Automating PA for long-acting reversible contraception, differentiating between ACA preventive service exemptions and PA-required scenarios.
• **High-Risk OB Imaging**: Managing time-sensitive PAs for advanced maternal-fetal imaging, such as detailed anatomy ultrasounds, fetal MRIs, and NIPT.
• **Minimally Invasive Surgery**: Streamlining authorizations for procedures like hysterectomy and myomectomy, including documentation of conservative-care trials.
• **Genetic Testing**: Validating indications for BRCA, expanded carrier screening, and NIPT against payer medical necessity criteria.

Optimizing Prior Authorization Workflows in eCW's Clinical Environment

Klivira integrates with key eClinicalWorks chart sections to ensure PA artifacts are where clinicians and staff need them. This includes depositing PA packets as DocumentReference entries into Progress Notes, routing status updates and payer correspondence to the Inbox / Task Management system, and surfacing PA detection within Orders / e-Prescribing workflows. For patient-facing communication related to PA, Klivira can interact with Healow modules as needed.

Mitigating Common OB/GYN Prior Authorization Denials

OB/GYN practices frequently encounter denials for insufficient conservative-care documentation for hysterectomies, genetic testing lacking medical necessity, or fertility services deemed non-covered. Klivira's platform incorporates payer-specific logic and documentation prompts to proactively address these common denial reasons, improving first-pass approval rates for procedures like endometrial ablation trials or required family history for genetic panels.

Klivira's Specific Capabilities for OB/GYN PA in eClinicalWorks

• **ACA Preventive Service Exemption Logic**: Automatically identifies and bypasses PA for services covered under ACA mandates.
• **Gestational-Age-Aware Routing**: Prioritizes and routes time-sensitive obstetric PAs to align with critical clinical windows.
• **Hysterectomy Documentation Logic**: Guides staff in collecting and submitting required conservative-care trial documentation.
• **Fertility Benefit Structure Routing**: Adapts PA workflows to the wide variability in per-plan fertility benefits, from diagnostic coverage to IVF cycle limits.
• **Integration with eCW's FHIR APIs**: Leverages resources like Patient, ServiceRequest, and DocumentReference for comprehensive data exchange.

Leveraging eCW's Interoperability for Enhanced PA Management

eClinicalWorks' commitment to interoperability, including its Open Interoperability Program and support for SMART App Launch, creates a robust foundation for Klivira's PA automation. This framework allows Klivira to securely access necessary patient and order data from eCW, process PA requests efficiently, and write back critical status updates and documents, ensuring the eCW EHR remains the single source of truth for patient care.