Elevating Epic Health Net Prior Authorization Automation

Klivira delivers robust Epic Health Net prior authorization automation, directly integrating with your Epic EMR to streamline the complex process of securing approvals from Health Net.

Revenue cycle leaders and prior authorization coordinators at large health systems using Epic frequently encounter friction when managing approvals for Health Net members. The manual effort of navigating disparate payer portals and fax workflows from within Hyperspace or Hyperdrive leads to context switching, delays, and increased administrative burden. Klivira addresses these challenges by automating key steps in the Epic Health Net prior authorization workflow.

The Epic-Health Net Prior Authorization Challenge

For Epic users, managing prior authorizations for Health Net, a prominent commercial and Medicare plan in California under Centene, often involves significant manual effort. Clinicians initiating orders in Hyperspace or Hyperdrive face context switching to access Health Net's specific portals or utilize traditional fax-based submissions, leading to fragmented workflows and potential delays. This disconnect impacts both efficiency and patient care pathways.

Klivira's Deep Integration with Epic EMR

Klivira integrates with Epic using advanced interoperability standards such as SMART on FHIR and CDS Hooks. This allows our platform to embed prior authorization workflows directly within the Epic environment, including Hyperspace and Hyperdrive. By leveraging FHIR R4 read/write capabilities for resources like ServiceRequest and DocumentReference, Klivira minimizes the need for staff to leave the EMR.

Key Epic Integration Points for PA Automation

**SMART App Launch**: Initiate Klivira workflows directly from Hyperspace or Hyperdrive with patient and encounter context.
**CDS Hooks**: Capture PA requirements at the point of order entry within the Orders activity, utilizing Da Vinci CRD-relevant hooks like `order-select` and `order-sign`.
**FHIR R4 Read/Write**: Securely access and update patient data, including depositing PA packets into Chart Review and Media sections via DocumentReference write.
**Inbasket Integration**: Route PA status updates and task assignments directly to the responsible care team within Epic's Inbasket.
**Bulk FHIR**: Support population-level operations for eligibility verification or comprehensive patient record aggregation via `Group/$export` and `Patient/$everything`.

Streamlining Health Net Prior Authorizations from Epic

Klivira's platform connects directly to Health Net's various prior authorization channels, including ePA portals and X12 278 transactions, to automate submission and status checks. For California-based providers, this means a unified approach to managing Health Net's commercial and Medicare plan requirements, reducing reliance on manual portal entries and phone calls. Our system aggregates necessary clinical documentation from Epic's Chart Review and Media sections to build complete submission packets.

Addressing Common Prior Authorization Pain Points for Epic Users

Klivira directly tackles the prior authorization pain points identified by Epic users, such as manual fax workflows and fragmented payer portal access. By centralizing the PA process and integrating it within the Epic EMR, we help eliminate context switching and streamline denial appeals workflows, ensuring that critical information is consistently captured and accessible.

Enhanced Visibility and Workflow for Health Net Approvals

With Klivira, prior authorization coordinators gain enhanced visibility into the status of Health Net requests directly within their Epic workflow. Our integration allows for automated updates to Epic's Inbasket and, where configured, visibility within Storyboard, ensuring that care teams are always informed about approval statuses, outstanding requirements, and next steps for Health Net members.

Frequently asked questions

How does Klivira integrate with Epic for Health Net prior authorizations?

Klivira integrates with Epic using SMART on FHIR, allowing launch directly from Hyperspace or Hyperdrive. We leverage FHIR R4 APIs for secure read access to patient data (e.g., ServiceRequest, DocumentReference) and write capabilities to deposit PA packets and status updates back into Epic, minimizing context switching.

Can Klivira handle both commercial and Medicare prior authorizations for Health Net members?

Yes, Klivira is designed to manage prior authorizations across Health Net's commercial and Medicare plans in California. Our platform connects to the specific channels required by Health Net for each plan type, ensuring comprehensive coverage for your patient population.

Does Klivira reduce manual data entry for Health Net prior authorizations?

Absolutely. By integrating directly with Epic, Klivira automates the extraction of clinical documentation from Chart Review and Media, assembling complete PA packets. This significantly reduces manual data entry into Health Net's portals and minimizes the need for fax-based submissions.

How does Klivira help with denial appeals for Health Net authorizations?

Klivira centralizes all documentation and communication related to Health Net prior authorizations within a single platform. This streamlined access to historical data and submission details simplifies the process of preparing and submitting denial appeals, improving efficiency in overturning unfavorable decisions.

Is Klivira certified or listed in Epic's App Orchard / Showroom?

Klivira is actively pursuing listing within Epic's Showroom (formerly App Orchard). Our technical integration aligns with Epic's interoperability standards, including SMART on FHIR and FHIR R4, ensuring a secure and compliant connection for our customers.

What specific Epic modules does Klivira interact with for prior authorizations?

Klivira interacts with key Epic modules including Orders activity for PA detection via CDS Hooks, Chart Review and Media for clinical documentation aggregation, and Inbasket for status updates and task routing. We also support launch from Hyperspace and Hyperdrive to maintain workflow continuity.