Greenway Health BCBS New York Prior Authorization Automation

Klivira delivers robust Greenway Health BCBS New York prior authorization automation, optimizing workflows for ambulatory practices using Intergy and Prime Suite.

Navigating prior authorization for BlueCross BlueShield New York plans from within Greenway Health's EMR environment presents unique challenges for revenue cycle directors and PA coordinators. The complexities of multiple BCBS entities in NY (Excellus, Highmark, Empire), varied submission channels, and specific policy requirements can lead to administrative burden and delays. Klivira addresses these pain points by integrating directly with your Greenway EMR to automate and accelerate the PA process for BCBS New York members.

Navigating BCBS New York Prior Authorization Channels

BlueCross BlueShield New York plans, including Empire BlueCross BlueShield, utilize diverse channels for prior authorization submissions. Medical PAs for commercial and Medicare Advantage plans are frequently routed through Availity Essentials, or via X12 278 transactions through clearinghouses. For specialized services like advanced imaging, cardiology, and musculoskeletal procedures, Empire leverages Carelon Medical Benefits Management (formerly AIM Specialty Health) for utilization management. Pharmacy PAs are processed through CarelonRx, the in-house PBM.

Klivira's Integration with Greenway Health EMRs

Klivira seamlessly integrates with Greenway Health's ambulatory EHR portfolio, including Intergy and Prime Suite. Our platform connects directly via the Greenway Marketplace, ensuring secure and efficient data exchange. This integration enables Klivira to pull necessary clinical documentation and patient demographics directly from the EMR, eliminating manual data entry and reducing the risk of errors in prior authorization requests for BCBS New York plans.

Streamlining Prior Authorization Workflows for NY Providers

For Greenway Health users, Klivira automates the routing of prior authorizations to the correct BCBS New York channel. Whether it's a medical PA to Availity, a high-cost imaging request to Carelon Medical Benefits Management, or a specialty drug PA to CarelonRx, Klivira ensures submissions follow the payer's designated path. This intelligent routing, combined with access to Empire's medical policies and New York-specific variations, helps ambulatory practices prepare accurate and complete requests the first time.

Addressing NY-Specific Regulatory Turnaround Times

New York State Department of Financial Services (DFS) regulations govern commercial prior authorization timeframes, while New York state Medicaid managed-care contracts dictate Medicaid PA processing. Additionally, CMS-0057-F applies to Medicare Advantage, Medicaid managed-care, CHIP, and QHP-on-FFM lines. Klivira's automation helps ambulatory practices using Greenway Health adhere to these critical deadlines, reducing administrative burden and improving compliance with state and federal mandates.

Optimizing High-Volume Service Lines

Klivira's platform is designed to optimize prior authorization for high-volume service lines often impacted by BCBS New York policies. This includes advanced imaging, outpatient surgical procedures, and specialty medications such as biologics. By automating the evidence collection and submission process, practices can reduce turnaround times for these critical services, ensuring patients receive timely access to necessary care.

Enhanced Efficiency for Ambulatory Practices

Implementing Klivira for Greenway Health BCBS New York prior authorization automation translates directly to enhanced operational efficiency for ambulatory practices. By minimizing manual tasks, staff can redirect their focus from administrative overhead to patient care. This leads to improved staff satisfaction, reduced claim denials due to incomplete or incorrect PAs, and ultimately, a healthier revenue cycle.

Frequently asked questions

How does Klivira handle different BCBS New York plans (Excellus, Highmark, Empire)?

Klivira's platform intelligently routes prior authorization requests based on the specific BCBS New York plan and the service being requested. We leverage the payer's designated channels, whether it's Availity Essentials for general medical PAs, Carelon Medical Benefits Management for specific services, or CarelonRx for pharmacy benefits, ensuring each request reaches the correct destination.

What types of prior authorizations are automated for Greenway Health users with BCBS New York?

Klivira automates a comprehensive range of prior authorizations for Greenway Health users, including medical PAs for advanced imaging, surgical procedures, and other services, as well as pharmacy PAs for specialty medications. This covers commercial, Medicare Advantage, and Medicaid managed care plans offered by BCBS New York.

Does Klivira integrate directly with Greenway Health's EMRs like Intergy and Prime Suite?

Yes, Klivira integrates directly with Greenway Health's EMR systems, including Intergy and Prime Suite, through the Greenway Marketplace. This enables seamless, secure, and bidirectional data exchange, allowing our platform to pull necessary patient and clinical data for prior authorization requests without manual intervention.

How does Klivira help with BCBS New York's specific policy requirements?

Klivira's platform incorporates payer-specific rules and access to policy libraries, such as those published by Empire BlueCross BlueShield, including New York-specific variations. This ensures that prior authorization requests are aligned with the payer's medical necessity criteria, improving the likelihood of approval and reducing resubmissions.

What are the benefits for an ambulatory practice using Greenway Health and Klivira?

Ambulatory practices using Greenway Health benefit from significantly reduced manual prior authorization work, faster turnaround times for approvals, and improved staff efficiency. Klivira helps minimize claim denials related to PAs, enhances compliance with NY state and federal regulations, and contributes to a more stable revenue cycle.