Optimizing Epic Prior Authorization for Genetic Testing

Klivira streamlines **Epic prior authorization for genetic testing**, integrating directly into your Hyperspace or Hyperdrive workflows to reduce manual burden and accelerate patient access to critical genomic services.

For large health systems and academic medical centers leveraging Epic, managing prior authorizations for high-volume genetic testing categories like hereditary cancer panels, prenatal, and pharmacogenomics presents significant operational challenges. Fragmented payer portals, manual fax workflows, and constant context switching out of Epic's clinical desktop impact revenue cycle efficiency and patient care timelines. Klivira addresses these pain points by embedding automation where it's needed most.

The Intersection of Epic Workflows and Genetic Testing PA

Genetic testing, encompassing hereditary cancer panels and pharmacogenomics, frequently requires prior authorization, often routed through specialized RBMs such as eviCore and Avalon Healthcare Services. Within Epic, clinicians typically initiate these complex orders via Hyperspace or Hyperdrive, necessitating a robust integration strategy to manage the associated PA requirements without disrupting the native order entry workflow.

Klivira's Deep Integration with Epic for Genetic Testing Orders

Klivira leverages Epic's advanced integration surfaces to embed prior authorization automation directly into the clinician's workflow. By utilizing SMART on FHIR, our platform can launch from within Hyperspace or Hyperdrive, providing patient and encounter context for genetic testing orders, and reducing the need for manual data entry or context switching. This ensures that PA requirements for hereditary cancer panels or prenatal genetic testing are addressed efficiently at the point of order.

Key Epic Integration Points for Genetic Testing PA Automation

**SMART on FHIR Launch:** Initiates Klivira directly from Hyperspace/Hyperdrive with patient and order context for genetic testing requests.
**CDS Hooks:** Surfaces coverage requirements for genetic testing orders (e.g., `order-select`, `order-sign`) within Epic's Orders activity, aligning with Da Vinci CRD principles.
**FHIR R4 Read/Write:** Accesses relevant clinical documentation (e.g., DocumentReference, ServiceRequest) from Chart Review and writes back PA status updates or authorization numbers.
**DocumentReference Write-back:** Deposits complete prior authorization packets, including supporting documentation for genetic tests, directly into Epic's Media section for clinician visibility.
**Inbasket Task Routing:** Facilitates communication of PA status changes or requests for additional information to the responsible care team within Epic's messaging module.

Addressing High-Volume Genetic Testing PA Challenges

Genetic testing categories like hereditary cancer panels, prenatal screening, and pharmacogenomics are often subject to complex and evolving payer policies, frequently managed by RBMs like eviCore and Avalon Healthcare Services. Klivira's automation platform is designed to navigate these intricacies, providing real-time eligibility and coverage checks, and streamlining the submission process for these high-volume, high-value services.

Enhanced Operational Efficiency and Data Exchange

Beyond core PA submission, Klivira utilizes Epic's FHIR R4 read capabilities for US Core resources (e.g., Coverage, ServiceRequest, Observation) to aggregate comprehensive clinical data required for genetic testing authorizations. Furthermore, our platform supports FHIR DocumentReference write-back for depositing complete authorization packets, ensuring all necessary documentation is available within Epic's Chart Review and Media sections, visible to your care teams.

Frequently asked questions

How does Klivira handle RBM-specific prior authorization requirements for genetic testing within Epic?

Klivira maintains connectivity with major RBMs like eviCore and Avalon Healthcare Services, which frequently manage genetic testing prior authorizations. Our platform automates the submission and tracking processes, adapting to their specific portal requirements and data needs, all while integrating the workflow seamlessly into your Epic environment.

Can Klivira help with prior authorization for hereditary cancer panels ordered in Epic?

Yes, hereditary cancer panels are a high-volume genetic testing category often requiring prior authorization. Klivira integrates with Epic's order entry workflows to detect these orders, initiate the PA process, and gather the necessary clinical documentation, reducing manual effort for your teams.

What Epic integration methods does Klivira use for genetic testing prior authorization?

Klivira primarily leverages SMART on FHIR for launching within Hyperspace/Hyperdrive, CDS Hooks for real-time PA requirement surfacing at order entry, and FHIR R4 read/write APIs (e.g., DocumentReference, ServiceRequest) for data exchange and write-back into Epic. We ensure alignment with USCDI standards where applicable.

How does Klivira ensure the prior authorization status for genetic tests is visible to Epic users?

Klivira can write back critical prior authorization status updates, authorization numbers, and complete PA packets as DocumentReference resources directly into Epic. This information is then accessible within Epic's Chart Review, Media, and can even trigger Inbasket notifications for relevant care team members, maintaining visibility within the native EMR.

Is Klivira available through Epic's App Orchard or Showroom?

Klivira is actively pursuing listing on Epic's Showroom (formerly App Orchard). Our integration strategy is built upon Epic's publicly available FHIR APIs and SMART App Launch framework, ensuring a robust and secure connection for our mutual customers.