Seamless Epic Clover Health Prior Authorization Automation

Klivira provides comprehensive **Epic Clover Health prior authorization automation**, integrating directly with Epic EMR workflows to streamline submissions for Medicare Advantage plans.

Revenue cycle teams navigating prior authorization for Medicare Advantage plans often face significant administrative burden, especially when managing requests from Epic Systems. The manual processes, context switching, and fragmented payer interactions required to secure authorizations for Clover Health members can lead to delays, increased costs, and potential claim denials. Klivira addresses these challenges by automating key steps in the PA lifecycle.

The Challenge of Epic to Clover Health Prior Authorizations

Large health systems utilizing Epic EMRs frequently encounter bottlenecks when submitting prior authorizations to Medicare Advantage plans like Clover Health. Clinicians and PA coordinators often resort to manual fax workflows or fragmented access to various payer portals, pulling them out of their native Hyperspace environment. This not only introduces inefficiency but also elevates the risk of errors and delays in care for Clover Health members.

Klivira's Integration with Epic for Enhanced PA Workflows

Klivira integrates deeply with Epic Systems, leveraging robust APIs to embed prior authorization automation directly into the clinician's workflow. Through **SMART on FHIR** capabilities, Klivira can launch directly from within Hyperspace or Hyperdrive, providing patient and encounter context without requiring manual data re-entry. This ensures PA requirements are addressed efficiently at the point of order entry.

Streamlining Clover Health Prior Authorization Submissions

For Clover Health members, Klivira automates the aggregation of necessary clinical documentation from Epic's Chart Review, Orders activity, and Media sections. While specific submission channels for Clover Health vary, Klivira's platform is designed to connect to diverse payer interfaces, including industry-standard ePA pathways or direct portal automation, to ensure timely and accurate transmission of authorization requests. This reduces the administrative burden associated with navigating multiple payer-specific requirements for Medicare Advantage services.

Operational Advantages for Your Health System

Reduce manual data entry and context switching for PA coordinators in Epic Hyperspace.
Accelerate prior authorization submission times for Clover Health Medicare Advantage plans.
Improve documentation accuracy by leveraging comprehensive patient data from Epic's FHIR APIs.
Enhance visibility into PA status updates directly within Epic's Inbasket or Storyboard.
Mitigate denial risks by ensuring complete and compliant PA packets for Clover Health.
Optimize resource allocation by automating routine PA tasks, allowing staff to focus on complex cases.

Klivira's Technical Approach to Epic Connectivity

Klivira utilizes Epic's **SMART App Launch** for seamless integration, supporting both EHR-launched workflows from Hyperspace/Hyperdrive and standalone access. We leverage **FHIR R4** read APIs for US Core resources like ServiceRequest, Coverage, and DocumentReference, and write-back capabilities for resources such as DocumentReference and Communication to ensure PA artifacts and status updates are visible within the Epic chart. Klivira's development adheres to Epic's **Showroom** (formerly App Orchard) guidelines, ensuring a secure and validated integration path.

Strategic Considerations for Medicare Advantage PA

Medicare Advantage plans, including Clover Health, often have specific medical policies and utilization management criteria that differ from traditional Medicare. Klivira's platform is designed to adapt to these payer-specific nuances, helping health systems manage the complexities of diverse service lines and drug classes that require prior authorization. This proactive approach helps reduce administrative overhead and ensures compliance with payer requirements.

Frequently asked questions

How does Klivira integrate with Epic to streamline prior authorizations for Clover Health?

Klivira integrates with Epic primarily via **SMART on FHIR**, enabling direct launch from Hyperspace or Hyperdrive. This allows us to pull relevant patient and encounter data from Epic using FHIR R4 APIs, and deposit PA-related documentation and status updates back into the chart, reducing manual data entry and context switching for Clover Health prior authorizations.

What specific Epic modules does Klivira interact with for prior authorization data?

Klivira interacts with several Epic modules to gather and deposit PA information. This includes reading clinical documentation from **Chart Review**, order details from the **Orders activity**, and patient attachments from **Media**. We also utilize write-back capabilities to update the patient chart with PA artifacts and status, which can be visible in areas like **Inbasket** or **Storyboard** for improved workflow visibility.

How does Klivira handle the varying prior authorization requirements of Clover Health as a Medicare Advantage plan?

Clover Health, as a Medicare Advantage plan, has specific medical policies. Klivira's platform is designed to adapt to these payer-specific rules by automating the collection of necessary clinical evidence from Epic and structuring the submission according to payer requirements. This helps ensure that authorization requests for Clover Health members are complete and accurate, minimizing potential denials.

Can Klivira help with denial appeals for Clover Health prior authorizations?

Yes, Klivira supports the denial appeals workflow by centralizing relevant clinical documentation from Epic and facilitating the assembly of comprehensive appeal packets. By maintaining a clear audit trail of prior authorization submissions and responses, Klivira helps your team efficiently manage and track appeals for Clover Health Medicare Advantage services, aiming to improve appeal success rates.

Is Klivira listed on Epic's App Orchard or Showroom?

Klivira adheres to Epic's integration guidelines and is pursuing listing on **Showroom** (formerly App Orchard). Our technical integration leverages Epic's public FHIR APIs and SMART App Launch framework, ensuring a secure and validated pathway for health systems to deploy Klivira within their Epic environment for enhanced prior authorization automation.