Streamlining Epic MetroPlusHealth Prior Authorization Automation

Klivira delivers robust Epic MetroPlusHealth prior authorization automation, empowering health systems to reduce manual effort and accelerate crucial approvals directly within clinical workflows.

For large health systems and academic medical centers utilizing Epic, managing prior authorizations for MetroPlusHealth, a significant New York Medicaid payer, presents unique operational challenges. The traditional approach often leads to fragmented workflows, context switching out of Hyperspace, and delays that impact patient care and revenue cycles. Klivira addresses these pain points by integrating directly with Epic to streamline MetroPlusHealth PA processes.

The Challenge of MetroPlusHealth Prior Authorizations within Epic

Revenue cycle directors and prior authorization coordinators frequently cite manual fax workflows, the need to context switch out of Epic's Hyperspace or Hyperdrive, and fragmented payer portal access as primary drivers of inefficiency for MetroPlusHealth prior authorizations. These challenges are compounded by the volume and specific requirements of Medicaid plans, leading to increased administrative burden and potential delays in patient access to care.

Klivira's Deep Integration with Epic Workflows

Klivira integrates directly with Epic via SMART on FHIR, enabling EHR-launch from within Hyperspace or Hyperdrive. This allows PA coordinators to initiate and manage MetroPlusHealth prior authorizations without leaving the patient chart. Our platform leverages Epic's FHIR R4 read APIs for US Core resources like Coverage, ServiceRequest, and DocumentReference to aggregate necessary clinical documentation, and utilizes FHIR R4 write APIs to deposit PA packets as DocumentReference, update ServiceRequest statuses, or send Communication and Task updates back into Epic's Inbasket.

Navigating MetroPlusHealth Prior Authorization Channels

Klivira connects to various payer channels, automating the submission and tracking of prior authorizations for plans like MetroPlusHealth. By supporting electronic prior authorization (ePA) standards and traditional submission methods, Klivira ensures comprehensive coverage for all MetroPlusHealth service lines. This approach consolidates the fragmented access to multiple payer portals, providing a unified platform for all MetroPlusHealth PA submissions.

Accelerating Approvals for Key Service Lines

For a Medicaid-focused payer like MetroPlusHealth, prior authorizations span a wide range of services, from specialty medications and advanced imaging to durable medical equipment (DME) and behavioral health. Klivira's automation capabilities are designed to accelerate approvals across these critical service lines. By automating documentation aggregation and submission, our platform helps reduce the administrative burden associated with high-volume or complex MetroPlusHealth requests, ensuring timely access to medically necessary care.

Key Benefits for Epic + MetroPlusHealth Users

Reduced context switching for PA coordinators within Epic's Hyperspace.
Automated submission and tracking of MetroPlusHealth PAs directly from the EMR.
Improved visibility into MetroPlusHealth PA status and requirements.
Streamlined aggregation of clinical documentation for MetroPlusHealth requests via FHIR.
Enhanced data accuracy and reduction of common denial reasons.
Support for CDS Hooks to surface coverage requirements at the point of order entry.

Technical Integration and Compliance Considerations

For IT integration leads, Klivira's connection to Epic is built on modern interoperability standards, including SMART on FHIR and FHIR R4 APIs. Klivira is pursuing listing on Epic's Showroom, ensuring a validated and secure integration path. All data exchange involving PHI between Epic and Klivira adheres to HIPAA regulations, with robust security protocols in place. Organizations should consult with their compliance teams to ensure alignment with internal policies and regulatory requirements.

Frequently asked questions

How does Klivira integrate with Epic for MetroPlusHealth prior authorizations?

Klivira integrates with Epic using SMART on FHIR for EHR-launched applications, allowing users to initiate PA workflows directly from Hyperspace or Hyperdrive. We leverage Epic's FHIR R4 APIs to read patient data for documentation and write back PA statuses, communications, and completed packets as DocumentReference resources into the patient chart.

Can Klivira help with MetroPlusHealth specific documentation requirements?

Yes, Klivira automates the aggregation of necessary clinical documentation from Epic's FHIR resources. This includes pulling relevant notes, lab results, and imaging reports required for MetroPlusHealth submissions, helping ensure comprehensive and accurate PA packets.

Does Klivira support write-back of PA statuses and authorization numbers to Epic?

Klivira supports write-back capabilities to Epic via FHIR R4 APIs. This allows for the deposit of completed prior authorization packets as DocumentReference resources, updates to ServiceRequest statuses, and sending Communication or Task notifications to Epic's Inbasket, ensuring the EMR remains the system of record.

Is Klivira an Epic App Orchard (Showroom) partner?

Klivira is actively engaged in the process of becoming a listed partner on Epic's Showroom. Our technical integration leverages Epic's public FHIR APIs and SMART on FHIR standards, adhering to Epic's recommended integration pathways for partner applications.

How does Klivira handle PHI when integrating with Epic and MetroPlusHealth?

Klivira prioritizes the secure and compliant handling of PHI. Our platform is designed with HIPAA-compliant security measures, including data encryption in transit and at rest, access controls, and auditing capabilities, ensuring the privacy and integrity of patient information throughout the prior authorization process.

What MetroPlusHealth service lines does Klivira support for prior authorization automation?

Klivira supports prior authorization automation for all service lines requiring MetroPlusHealth approval. This includes, but is not limited to, specialty medications, advanced imaging, surgical procedures, durable medical equipment, and behavioral health services, streamlining the process across the full spectrum of care.