Epic Priority Health Prior Authorization Automation

Klivira delivers robust Epic Priority Health prior authorization automation, empowering Michigan health systems to streamline workflows and accelerate approvals directly within their Epic environment.

Navigating prior authorizations for Priority Health within an Epic EMR presents unique challenges, often leading to manual processes, context switching, and delays. Klivira's platform is engineered to integrate seamlessly with Epic, providing a unified solution that addresses these operational bottlenecks and enhances efficiency for revenue cycle directors and prior authorization coordinators.

Addressing Priority Health PA Challenges within Epic

For healthcare organizations utilizing Epic, managing prior authorizations for a regional payer like Michigan-based Priority Health frequently involves fragmented workflows. This can mean manual fax submissions, navigating disparate payer portals, and significant context switching away from Hyperspace or Hyperdrive, directly impacting staff productivity and increasing the risk of delayed care or denials. Klivira centralizes these interactions, reducing the administrative burden.

Deep Integration with Epic for Enhanced PA Workflows

Klivira leverages Epic's advanced integration surfaces to embed prior authorization automation directly into the clinician workflow. Our platform utilizes SMART on FHIR for secure, context-aware app launch from within Hyperspace or Hyperdrive, ensuring patient and encounter data are seamlessly passed. We also employ FHIR R4 read capabilities for US Core resources like ServiceRequest, MedicationRequest, and DocumentReference, alongside FHIR R4 write capabilities to deposit critical PA artifacts such as DocumentReference for submitted packets, ServiceRequest updates, and Communication entries directly into the patient's Chart Review and Inbasket.

Key Epic Integration Points for Prior Authorization

**SMART on FHIR Launch**: Initiated from Hyperspace/Hyperdrive, providing patient and encounter context.
**CDS Hooks**: Supporting `order-select` and `order-sign` to detect PA requirements at the point of order entry.
**FHIR R4 Read/Write**: Accessing clinical documentation (e.g., DocumentReference, ServiceRequest) and writing back PA status updates and authorization numbers.
**Inbasket Task Routing**: Delivering PA status notifications and requests for information directly to relevant Epic users.
**Chart Review Visibility**: Ensuring all submitted PA documentation and authorization details are accessible within the patient's chart.

Streamlining Priority Health Connectivity

Klivira connects to Priority Health through a robust network of digital channels, automating the submission and tracking of prior authorizations. This includes supporting electronic prior authorization (ePA) standards where available, integrating with payer portals, and leveraging X12 278 transactions. Our system intelligently routes requests based on payer requirements, ensuring that each Priority Health submission is complete and compliant, reducing manual data entry and follow-up.

Impact on High-Volume Service Lines and Specialties

For health systems managing a diverse patient population, Klivira's automation is critical across various service lines. This includes high-volume areas such as specialty medications (e.g., biologics, GLP-1s), advanced imaging (MRI, CT scans), and complex surgical procedures, all frequently requiring prior authorization from Priority Health. By automating these processes, organizations can minimize delays in patient care and optimize revenue capture for these critical services.

Frequently asked questions

How does Klivira integrate with Epic's Hyperspace/Hyperdrive?

Klivira integrates using SMART on FHIR, allowing our application to launch directly from within Hyperspace or Hyperdrive. This provides single sign-on and passes patient and encounter context, eliminating the need for staff to log into separate systems or manually search for patient data, keeping the workflow centralized within Epic.

Can Klivira write authorization statuses back into Epic?

Yes, Klivira leverages Epic's FHIR R4 write capabilities for specific resources. This allows us to write back critical information such as authorization numbers, status updates, and submitted documentation (as DocumentReference) directly into the patient's chart, making it visible in Chart Review and updating relevant ServiceRequest records.

How does Klivira handle different types of prior authorizations for Priority Health?

Klivira's platform is designed to manage a comprehensive range of prior authorization types for Priority Health, including those for medications, procedures, and imaging. Our system intelligently adapts to Priority Health's specific requirements, whether through ePA, payer portals, or X12 278, ensuring accurate and compliant submissions for diverse service lines.

Does Klivira use CDS Hooks for Epic prior authorization workflows?

Yes, Klivira utilizes CDS Hooks, including `order-select` and `order-sign`, to identify prior authorization requirements at the point of order entry within Epic. This proactive approach helps clinicians and staff address PA needs earlier in the workflow, preventing downstream delays and improving efficiency.

Is Klivira compatible with both Epic Hyperspace and Hyperdrive?

Klivira is designed to be compatible with both Epic Hyperspace and the newer, Chromium-based Hyperdrive. Our integration ensures a consistent and seamless user experience regardless of the Epic client version deployed by your health system, supporting modern web standards within Hyperdrive while maintaining functionality in Hyperspace.