Epic Fidelis Care Prior Authorization Automation: Streamlining Workflows

Klivira delivers robust **Epic Fidelis Care prior authorization automation**, integrating directly into your Epic workflow to eliminate manual tasks and accelerate approvals for New York Medicaid and Medicare plans.

Managing prior authorizations for Fidelis Care patients within an Epic environment presents unique challenges. Revenue cycle directors and PA coordinators frequently navigate fragmented payer portals, manual documentation, and context switching outside of Epic Hyperspace, leading to delays and administrative burden. Klivira addresses these operational inefficiencies by unifying the PA process.

The Epic Fidelis Care Prior Authorization Challenge

For large health systems and academic medical centers utilizing Epic, prior authorization for Fidelis Care's New York Medicaid and Medicare plans often involves extensive manual effort. This includes navigating multiple payer portals, submitting faxes, and constantly switching context out of Epic Hyperspace or Hyperdrive. This fragmented approach contributes to delays, increased denial rates, and significant administrative burden on PA coordinators.

Klivira's Integration with Epic for Fidelis Care Workflows

Klivira integrates directly with Epic, leveraging advanced interoperability standards to automate prior authorization for Fidelis Care. Our platform utilizes SMART on FHIR for seamless EHR-launch within Hyperspace, allowing PA requests to be initiated with full patient and encounter context. We also employ CDS Hooks, specifically `order-select` and `order-sign`, to surface Fidelis Care coverage requirements at the point of order entry, preventing retrospective denials.

Key Epic Integration Capabilities for Prior Authorization

**SMART App Launch:** Initiates Klivira directly from Epic Hyperspace/Hyperdrive with contextual patient and encounter data.
**CDS Hooks:** Provides real-time prior authorization requirements from Fidelis Care at the moment an order is placed in Epic's Orders activity.
**FHIR R4 Read/Write:** Exchanges critical clinical data (e.g., ServiceRequest, DocumentReference, Condition, Observation) between Epic and Klivira for comprehensive PA packet assembly and status updates.
**Write-back to Epic:** Deposits completed authorization packets as DocumentReference entries, updates ServiceRequest statuses, and routes communication and tasks to Epic Inbasket.
**Bulk FHIR:** Supports `Group/$export` and `Patient/$everything` for population-level eligibility verification and longitudinal patient record aggregation, particularly useful for high-volume Fidelis Care panels.

Streamlining Fidelis Care PA Submissions

Klivira centralizes and automates the submission process for Fidelis Care prior authorizations, whether through their proprietary payer portals or standard ePA channels. By consolidating data from Epic and automating form submission, we significantly reduce manual data entry and human error, accelerating approvals for critical services and high-cost medications covered by Fidelis Care's Medicaid and Medicare plans in New York.

Enhancing Prior Authorization Workflows within Epic

Our solution ensures that PA-relevant information remains visible and actionable within Epic. Authorization statuses, supporting documentation, and next steps are integrated into Epic's Chart Review, Orders activity, Media, and Inbasket. This approach keeps PA coordinators and clinicians within their familiar Hyperspace/Hyperdrive environment, minimizing context switching and enhancing operational efficiency for Fidelis Care patients.

The Klivira Advantage for Epic + Fidelis Care

By automating the **Epic Fidelis Care prior authorization automation** workflow, Klivira helps your organization achieve faster approval times, reduce administrative overhead, and improve financial outcomes. Our platform is designed to handle the complexities of Medicaid and Medicare PA requirements, ensuring your staff can focus on patient care rather than paperwork.

Frequently asked questions

How does Klivira integrate with Epic for Fidelis Care prior authorizations?

Klivira integrates using Epic's SMART on FHIR capabilities for secure, contextual launches from Hyperspace, and leverages FHIR R4 APIs for robust clinical data exchange. We also utilize CDS Hooks to provide real-time PA requirements at the point of order entry within Epic, specifically for Fidelis Care plans.

Can Klivira help with Fidelis Care Medicaid and Medicare prior authorizations?

Yes, Klivira is designed to streamline prior authorizations across various payer lines, including Fidelis Care's Medicaid and Medicare plans in New York. Our automation platform adapts to the specific requirements and channels for these high-volume patient populations.

Does Klivira reduce the need to access the Fidelis Care payer portal?

Klivira centralizes the prior authorization process, significantly reducing the need for manual access to individual Fidelis Care payer portals. Our system automates data submission and status tracking, keeping your team within Epic for most PA-related tasks.

What Epic modules does Klivira interact with for PA workflows?

Klivira interacts with key Epic modules including Chart Review (for documentation), Orders activity (for PA initiation and CDS Hooks), Media (for depositing PA packets), and Inbasket (for task routing and status updates), ensuring a cohesive workflow within Hyperspace/Hyperdrive.

How does Klivira handle documentation for Fidelis Care PA requests from Epic?

Klivira aggregates necessary clinical documentation from Epic via FHIR R4 queries, assembling comprehensive PA packets. Upon approval, the complete authorization record is written back to Epic as a DocumentReference, ensuring all relevant artifacts are accessible within the patient's chart.