Epic SCAN Health Plan Prior Authorization Automation

Klivira delivers robust Epic SCAN Health Plan prior authorization automation, directly integrating with Epic EMR workflows to accelerate approvals and reduce administrative burden for Medicare Advantage cases.

For large health systems and academic medical centers leveraging Epic, managing prior authorizations for Medicare Advantage plans like SCAN Health Plan presents significant operational challenges. The manual processes, context switching out of Hyperspace, and fragmented payer portal access often lead to delays, increased denial rates, and clinician burnout. Klivira provides a purpose-built solution to automate and streamline these critical workflows.

Navigating Prior Authorization for SCAN Health Plan within Epic

Revenue cycle teams and prior authorization coordinators often face a complex landscape when submitting requests to SCAN Health Plan from Epic. The process frequently involves manual data extraction, navigating external payer portals, and managing fax queues—all outside the core Epic Hyperspace or Hyperdrive environment. This fragmentation is particularly acute for Medicare Advantage cases, where specific rules and documentation requirements can vary significantly.

Klivira's Deep Integration with Epic EMR

Klivira integrates directly with Epic, leveraging the full suite of Epic's interoperability surfaces to embed prior authorization automation into existing clinical and administrative workflows. Our solution utilizes SMART on FHIR for EHR-launch capabilities, allowing users to initiate and manage prior authorizations directly from within Hyperspace or Hyperdrive, maintaining patient and encounter context. We also leverage FHIR R4 read/write capabilities for critical resources like DocumentReference and ServiceRequest, ensuring that all necessary clinical documentation and authorization statuses are accurately exchanged and reflected in the patient chart.

Key Epic Integration Capabilities

**SMART App Launch**: Seamless EHR-launch from Hyperspace/Hyperdrive, preserving patient context.
**FHIR R4 Write-Back**: Depositing PA packets as DocumentReference, updating ServiceRequest statuses, and routing communications to Inbasket.
**CDS Hooks**: Surfacing prior authorization requirements at the point of order entry (e.g., via `order-select` and `order-sign` hooks for Da Vinci CRD-aware workflows).
**USCDI Conformance**: Ensuring adherence to data exchange standards for comprehensive clinical documentation.
**Showroom Listing Path**: Klivira is pursuing a listing on Epic's Showroom, facilitating streamlined adoption and deployment for Epic customers.

Optimizing Prior Authorization for SCAN Health Plan

Klivira's platform is designed to automate the diverse prior authorization requirements of payers like SCAN Health Plan. Our system connects to payer portals, supports X12 278 transactions, and facilitates ePA submissions, abstracting away the complexity of payer-specific channels. For SCAN's Medicare Advantage focus, this means automating common high-volume requests such as imaging, specialty medications, and complex procedures often associated with senior care, ensuring that the right documentation reaches the payer efficiently.

Operational Advantages for Revenue Cycle and Clinical Teams

By automating Epic SCAN Health Plan prior authorization, Klivira significantly reduces the administrative burden on your staff. Our solution minimizes context switching for PA coordinators, allowing them to work within a unified platform that integrates with Epic. This leads to faster turnaround times, reduced denial rates, and improved resource allocation, ultimately enhancing both financial performance and clinician satisfaction by keeping them focused on patient care.

Frequently asked questions

How does Klivira integrate with Epic for SCAN Health Plan prior authorizations?

Klivira integrates with Epic using SMART on FHIR for EHR-launch, allowing users to initiate PA workflows directly from Hyperspace or Hyperdrive. We also leverage FHIR R4 read and write APIs to extract necessary clinical data and write back authorization statuses and documentation, such as DocumentReference and ServiceRequest updates, into the Epic chart.

What types of services does Klivira automate for SCAN Health Plan Medicare Advantage cases?

Klivira automates a wide range of prior authorization requests relevant to SCAN Health Plan's Medicare Advantage population. This includes, but is not limited to, imaging studies, specialty medications, durable medical equipment (DME), and complex surgical procedures, streamlining the submission and tracking process for high-cost or high-volume services.

Does Klivira reduce context switching for Epic users handling SCAN Health Plan PAs?

Yes, a primary benefit of Klivira's integration is the significant reduction in context switching. By embedding prior authorization workflows directly within Epic via SMART on FHIR, users can manage SCAN Health Plan requests without leaving Hyperspace or Hyperdrive, accessing all necessary information and submitting requests from a familiar environment.

How does Klivira handle documentation and status updates for SCAN PAs within Epic?

Klivira utilizes Epic's FHIR R4 write capabilities to ensure comprehensive documentation. We can deposit complete prior authorization packets as DocumentReference resources within the patient's chart and update ServiceRequest statuses. Additionally, relevant communications and task assignments can be routed to Epic's Inbasket, keeping all stakeholders informed.

Is Klivira compatible with both Epic Hyperspace and Hyperdrive environments?

Yes, Klivira is designed for compatibility with both Epic Hyperspace and the newer, Chromium-based Hyperdrive. Our SMART on FHIR application ensures a consistent and seamless user experience, adapting to the specific browser model and capabilities of your Epic deployment.