Greenway Health Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers comprehensive Greenway Health Anthem (Elevance Health) prior authorization automation, streamlining submissions and accelerating approvals for ambulatory practices.

Ambulatory practices leveraging Greenway Health's Intergy or Prime Suite EHR face significant administrative burdens managing prior authorizations for Anthem-licensed plans. The complexity of payer-specific channels, evolving medical policies, and manual data entry from the EHR to external portals creates bottlenecks and delays in patient care. Klivira addresses these challenges by integrating directly with your Greenway EHR, automating the submission process to Anthem's diverse pathways.

The Prior Authorization Challenge for Greenway Health Users with Anthem

Greenway Health's ambulatory focus means practices frequently encounter a diverse range of Anthem prior authorization requirements across medical, pharmacy, and specialty benefits. Manually navigating these from Intergy or Prime Suite to external portals like Availity or Carelon Medical Benefits Management introduces significant overhead, potential for errors, and increased administrative costs. Efficiently managing these varied workflows is critical for maintaining revenue cycle integrity and ensuring timely patient access to care.

Understanding Anthem (Elevance Health) Prior Authorization Channels

Anthem-licensed plans, part of Elevance Health, utilize multiple distinct channels for prior authorization submissions. Medical benefit PAs for commercial and Medicare Advantage plans primarily route through Availity Essentials, Anthem's multi-payer provider workspace, or via X12 278 transactions through clearinghouses. Pharmacy PAs are managed by CarelonRx (formerly IngenioRx), often leveraging CoverMyMeds or Surescripts ePA for prescriber-initiated workflows. Specialized services, such as advanced imaging, cardiology, and MSK, are managed by Carelon Medical Benefits Management (formerly AIM Specialty Health) through its dedicated provider portal.

Key Anthem (Elevance Health) PA Submission Pathways for Greenway Health Users

**Availity Essentials:** Primary channel for most commercial and Medicare Advantage medical benefit prior authorizations, including inpatient admission notification.
**X12 278 Transactions:** Supported for eligible medical procedures, enabling electronic submission via clearinghouses.
**Carelon Medical Benefits Management (MBM):** Dedicated portal for specialty benefit management domains like advanced imaging, cardiology, MSK, sleep, and radiation oncology.
**CarelonRx (CoverMyMeds/Surescripts):** For retail pharmacy benefit prior authorizations via ePA partners.
**Carelon Behavioral Health:** Manages behavioral health services for many Anthem lines; verify carve-out status per line of business and state.

Klivira's Seamless Integration with Greenway Health

Klivira integrates directly with Greenway Health's Intergy and Prime Suite EHRs, accessible via the Greenway Marketplace. This integration establishes a secure, bi-directional data flow, extracting necessary clinical documentation, patient demographics, and order details to pre-populate prior authorization requests. This reduces manual transcription, improves data accuracy, and ensures that all relevant information from the patient's record is available for the PA submission, directly within your Greenway workflow.

Automating Anthem Prior Authorizations with Klivira

Klivira automates the submission process to Anthem's various channels. For medical benefit PAs, Klivira can leverage X12 278 capabilities where supported and streamline Availity submissions. For pharmacy benefits, Klivira integrates with ePA partners like CoverMyMeds and Surescripts via CarelonRx. Crucially, Klivira also supports routing to specialty benefit managers such as Carelon Medical Benefits Management, ensuring that even complex cases for imaging or MSK services are directed to the correct portal with complete documentation. This comprehensive approach minimizes manual burden across all Anthem PA types.

Navigating Complex Policy and Specialty Benefits

Klivira assists Greenway Health users in navigating Anthem's complex utilization management policies, including those from Carelon Medical Benefits Management for services like advanced imaging or MSK. Our platform helps identify the correct submission channel and required documentation based on the specific service and Anthem plan, supporting compliance with state-specific regulations and CMS-0057-F for impacted Medicare Advantage, Medicaid, and QHP lines of business. Klivira streamlines access to relevant medical policies and clinical guidelines, ensuring submissions meet payer criteria.

Frequently asked questions

How does Klivira handle the different Anthem PA portals and channels?

Klivira's platform is designed to manage Anthem's multi-channel submission landscape. We automate submissions to Availity Essentials for general medical PAs, leverage X12 278 where applicable, integrate with ePA partners like CoverMyMeds and Surescripts for pharmacy benefits, and route specialty requests to the Carelon Medical Benefits Management portal for in-scope services. This ensures each PA is directed to the appropriate channel without manual intervention.

Is Klivira compatible with both Greenway Intergy and Prime Suite?

Yes, Klivira is engineered for seamless integration with both Greenway Intergy and Prime Suite EHRs. Our solution is available through the Greenway Marketplace, providing ambulatory practices with direct access to prior authorization automation capabilities from within their existing Greenway workflow, regardless of their specific Greenway platform.

How does Klivira assist with prior authorizations for services managed by Carelon Medical Benefits Management?

For services like advanced imaging, cardiology, or MSK that are managed by Carelon Medical Benefits Management, Klivira automates the submission process to their dedicated provider portal. Our system extracts the necessary clinical data from your Greenway EHR and populates the Carelon MBM request, ensuring that the correct clinical guidelines are referenced and all required documentation is included for a timely decision.

Can Klivira help ambulatory practices using Greenway access Anthem's medical policies and guidelines?

While Klivira does not provide legal or compliance advice, our platform is designed to streamline the PA workflow by facilitating the submission of documentation aligned with payer policies. Klivira helps ensure that the information submitted for an Anthem PA references the correct medical policy or clinical guideline, whether it's from Anthem's state-specific libraries via Availity or Carelon MBM's own published criteria, supporting informed decision-making for your compliance team.

What are the benefits of automating Anthem PAs for Greenway Health users?

Automating Anthem prior authorizations with Klivira offers significant benefits for Greenway Health users, including reduced administrative burden, accelerated turnaround times, and fewer denials due to incomplete or inaccurate submissions. By integrating directly with Intergy and Prime Suite, Klivira minimizes manual data entry, optimizes staff utilization, and ultimately improves patient access to necessary care by expediting the PA process across Anthem's diverse channels.