Accelerating Epic Security Health Plan Prior Authorization Automation

Klivira streamlines **Epic Security Health Plan prior authorization automation**, reducing the administrative burden for healthcare providers in Wisconsin and ensuring timely patient care.

For large health systems and academic medical centers utilizing Epic, managing prior authorizations for payers like Security Health Plan often involves significant manual effort and context switching. This fragmentation between EMR workflows and payer-specific requirements can delay care, increase operational costs, and contribute to staff burnout. Klivira provides a purpose-built solution to integrate these disparate processes.

Addressing Prior Authorization Challenges with Security Health Plan from Epic

Providers in Wisconsin leveraging Epic for patient care frequently encounter manual prior authorization workflows when dealing with Security Health Plan. This often necessitates navigating external payer portals or relying on fax and phone, pulling staff away from Epic's Hyperspace or Hyperdrive environment and disrupting the order entry process. The lack of real-time status updates and fragmented documentation contribute to delays and increased denial rates.

Seamless Integration with Epic for Enhanced Efficiency

Klivira's platform is engineered to integrate directly with Epic, leveraging industry-standard interfaces to embed prior authorization workflows within the clinician's existing environment. By utilizing SMART on FHIR, Klivira reduces the need for context switching, allowing prior authorization tasks to be initiated and managed without leaving Epic's Hyperspace or Hyperdrive. This direct integration minimizes manual data entry and ensures that necessary clinical documentation is readily accessible for Security Health Plan submissions.

Klivira's Epic Integration Capabilities

**SMART App Launch**: Launch Klivira directly from Epic's Hyperspace/Hyperdrive, inheriting patient and encounter context.
**FHIR R4 Read/Write**: Securely access patient data (e.g., ServiceRequest, DocumentReference) and write back authorization statuses and documents into Epic's Chart Review or Media tabs.
**CDS Hooks**: Leverage `order-select` and `order-sign` hooks to identify prior authorization requirements for Security Health Plan at the point of order entry.
**Inbasket Integration**: Route prior authorization status updates, peer-to-peer review requests, and task assignments directly to the responsible Epic user's Inbasket.
**Bulk FHIR**: Utilize `Patient/$everything` for comprehensive clinical history extraction, streamlining the assembly of documentation required for Security Health Plan.

Optimizing Prior Authorization Workflows for Security Health Plan

Klivira automates the submission process for various services requiring prior authorization from Security Health Plan, from high-volume imaging and surgical procedures to specialty medications. By consolidating payer-specific rules and automating the assembly of clinical evidence, Klivira helps ensure that requests are complete and accurate before submission, reducing the likelihood of denials and accelerating approval times. This enables providers to focus on patient care rather than administrative overhead.

Secure Data Exchange and Compliance Considerations

Klivira prioritizes the secure exchange of PHI between Epic and Security Health Plan. All integrations adhere to HIPAA security standards, ensuring data integrity and confidentiality. Organizations should consult with their compliance teams to ensure that all data flows and access permissions align with their specific policies and any applicable state or federal regulations, including those outlined by ONC Cures Update API requirements for EMRs like Epic.

The Klivira Advantage for Epic and Security Health Plan Users

By automating the prior authorization process, Klivira empowers healthcare organizations using Epic to achieve significant operational efficiencies when interacting with Security Health Plan. This leads to faster approval times, reduced administrative costs, improved staff satisfaction, and ultimately, quicker access to necessary care for patients across Wisconsin.

Frequently asked questions

How does Klivira integrate with Epic's order entry workflow for Security Health Plan?

Klivira leverages Epic's SMART on FHIR capabilities and CDS Hooks, specifically `order-select` and `order-sign`. This allows Klivira to surface prior authorization requirements for Security Health Plan at the point of order entry within Hyperspace or Hyperdrive, guiding clinicians through the process without leaving their native Epic environment.

Can Klivira write prior authorization status updates back into Epic for Security Health Plan cases?

Yes, Klivira utilizes Epic's FHIR R4 write capabilities to update patient charts. This includes depositing approved prior authorization packets as DocumentReference entries, updating ServiceRequest statuses, and routing notifications or tasks related to Security Health Plan prior authorizations directly to the relevant user's Inbasket within Epic.

What level of patient data does Klivira access from Epic for Security Health Plan prior authorizations?

Klivira accesses only the patient data necessary for prior authorization submissions, adhering to the principle of least privilege. This typically includes clinical documentation, orders, and patient demographics available via Epic's FHIR R4 read APIs (e.g., Patient, Coverage, ServiceRequest, DocumentReference, Observation, Condition). All access is governed by SMART on FHIR scopes and customer-defined permissions.

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

Klivira is actively pursuing listing within Epic's Showroom (formerly App Orchard). Our integration strategy is built upon the technical specifications and APIs provided by Epic, ensuring a robust and compliant connection for our mutual customers.

How does Klivira handle the variability of Security Health Plan's prior authorization requirements?

Klivira's platform is designed to adapt to payer-specific rules and documentation requirements. By maintaining an up-to-date library of prior authorization policies, Klivira can guide users through the specific steps and data points needed for Security Health Plan submissions, ensuring accuracy and completeness for various service lines and drug classes.