Epic Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers comprehensive Epic Anthem (Elevance Health) prior authorization automation, integrating directly with your Epic EMR to manage complex medical and pharmacy benefit requests for Anthem plans.

Revenue cycle directors and prior authorization coordinators face significant challenges managing prior authorizations for Anthem (Elevance Health) plans from within Epic Systems. The current workflow often involves manual faxing, extensive context switching out of Hyperspace, and navigating fragmented payer portals like Availity and Carelon Medical Benefits Management. Klivira addresses these pain points by orchestrating a seamless, automated prior authorization process.

Navigating Anthem (Elevance Health) Prior Authorizations from Epic

Anthem, operating under Elevance Health, requires prior authorization across a wide range of medical and pharmacy services. Submitting these requests from Epic often forces clinicians and PA teams to exit their primary workflow, access multiple external portals such as Availity for medical PAs, or Carelon Medical Benefits Management for specialty services like advanced imaging and cardiology. This fragmentation introduces delays and increases the risk of manual errors.

Klivira's Deep Integration with Epic Systems

Klivira's platform integrates directly with Epic, leveraging modern interoperability standards to embed prior authorization workflows within the clinician's existing environment. Our approach minimizes context switching and keeps critical PA information accessible where it's needed most, whether in Hyperspace or Hyperdrive.

Key Epic Integration Capabilities:

SMART on FHIR Launch: Initiate PA requests directly from Epic Hyperspace/Hyperdrive with patient and encounter context.
FHIR R4 Read/Write: Access US Core resources (e.g., ServiceRequest, Coverage, Patient) and write back critical PA documents (DocumentReference) and status updates to the patient chart.
CDS Hooks: Surface prior authorization requirements at the point of order entry (e.g., `order-select`, `order-sign`) using Da Vinci CRD-relevant hooks.
Showroom Listing: Klivira follows the Epic Showroom path to ensure validated and secure integration for Epic customers.

Streamlined Connectivity to Anthem (Elevance Health) Channels

Klivira centralizes and automates prior authorization submissions to Anthem (Elevance Health) across all their required channels. This includes medical benefit PAs via Availity Essentials, pharmacy benefit PAs through CarelonRx's ePA partners (CoverMyMeds, Surescripts), and specialty benefit management for services like advanced imaging through Carelon Medical Benefits Management. We also support X12 278 transactions for efficient electronic data interchange.

Accelerating Complex PA Workflows for Anthem Plans

Our platform is designed to handle the nuances of Anthem's diverse prior authorization requirements, from standard medical procedures to complex specialty drugs and imaging. By automating documentation aggregation from Epic's Chart Review and Media sections, intelligently routing requests to the correct Anthem channel (e.g., Availity vs. Carelon MBM), and tracking policy requirements from Anthem's medical-policy libraries, Klivira significantly reduces the administrative burden. This includes supporting the phased compliance timeline for CMS-0057-F for Anthem's Medicare Advantage and Medicaid plans.

Frequently asked questions

How does Klivira integrate with Epic for Anthem prior authorizations?

Klivira integrates with Epic using SMART on FHIR, allowing launch directly from Hyperspace or Hyperdrive. We leverage FHIR R4 APIs to read patient data and write back critical PA documents (DocumentReference) and status updates, ensuring continuity of information within the Epic EMR. Our integration also supports CDS Hooks for real-time PA requirement checks at order entry.

Which Anthem (Elevance Health) PA submission channels does Klivira support?

Klivira supports all primary Anthem (Elevance Health) prior authorization channels. This includes Availity Essentials for general medical PAs, Carelon Medical Benefits Management for specialty services like advanced imaging, and ePA partners like CoverMyMeds and Surescripts for pharmacy PAs via CarelonRx. We also facilitate X12 278 transactions for payers that support this standard.

Can Klivira help with imaging prior authorizations for Anthem plans routed through Carelon Medical Benefits Management?

Yes, Klivira automates the prior authorization process for advanced imaging and other specialty services routed through Carelon Medical Benefits Management. Our platform intelligently identifies these cases, aggregates necessary clinical documentation from Epic, and routes the submission through the appropriate Carelon MBM pathway, streamlining a historically complex workflow.

How does Klivira handle pharmacy prior authorizations for Anthem (Elevance Health) plans?

For pharmacy benefit PAs with Anthem (Elevance Health) plans, Klivira integrates with CarelonRx's electronic prior authorization (ePA) partners, CoverMyMeds and Surescripts. This enables prescribers to initiate and manage pharmacy PAs directly from their existing workflows, reducing manual steps and accelerating medication access.

Does Klivira assist with denial appeals for Anthem prior authorizations?

Yes, Klivira streamlines the denial appeals process for Anthem (Elevance Health) prior authorizations. Our platform helps organize and submit necessary documentation for appeals, whether through the standard Anthem operating-company appeal pathway or the separate Carelon Medical Benefits Management appeal process, improving efficiency and tracking for your team.