Accelerate eMDs eviCore Integration for Prior Authorizations

Deep Integration with CGM eMDs for eviCore Workflows

Klivira establishes a robust connection with CGM eMDs, formerly known as eMDs Solution Series, leveraging its CGM APIs to embed prior authorization workflows directly within the ambulatory practice environment. This ensures that the initiation and tracking of eviCore authorizations are contextual to patient care and order entry.

Seamless Data Flow for eviCore Submissions within eMDs

• **Order Entry Module:** Automatically trigger authorization requests when eviCore-managed services (e.g., specific radiology CPT codes) are ordered.
• **Patient Chart:** Extract relevant patient demographics, insurance details, and clinical history for comprehensive submissions.
• **Clinical Documentation:** Access diagnosis codes (ICD-10) and supporting clinical notes crucial for medical necessity review.
• **Provider Desktop:** Enable providers to review and attest to clinical information prior to submission, directly within their familiar eMDs interface.
• **Referral Management:** Integrate with existing referral workflows to ensure eviCore requirements are met upfront.

Leveraging eMDs Data and Klivira's Payer Connectivity

Klivira utilizes the structured and unstructured data exposed through CGM eMDs APIs, including patient identifiers, CPT/HCPCS codes, ICD-10 diagnoses, and clinical notes. This EMR-sourced data forms the foundation for automated submissions. Klivira then complements this by interacting directly with eviCore's systems, whether via X12 278 transactions or their proprietary ePA portals, to retrieve specific payer requirements and submit complete authorization requests.

Automating eviCore Authorization Status Updates in eMDs

Post-submission, Klivira continuously monitors the status of eviCore authorizations. Once a determination is made, Klivira automatically ingests the decision (approved, denied, pended) and the associated authorization number. This critical information is then written back into the appropriate fields within the CGM eMDs patient record, ensuring the EMR remains the single source of truth for patient care and administrative data.

Operational Benefits for eMDs Users Managing eviCore

Implementing a dedicated eMDs eviCore integration through Klivira significantly reduces the manual burden on prior authorization coordinators. By automating data extraction, submission, and status updates, practices can reallocate staff resources, minimize errors from re-keying information, and accelerate patient access to vital radiology, cardiology, and musculoskeletal services managed by eviCore.