Greenway Health Fidelis Care Prior Authorization Automation

Klivira delivers robust Greenway Health Fidelis Care prior authorization automation, directly addressing the complexities faced by New York ambulatory practices. We streamline the entire PA lifecycle, from submission to determination, within your existing EMR workflow.

For practices utilizing Greenway Health EMR, managing prior authorizations for Fidelis Care patients in New York often involves navigating disparate payer portals or manual processes. This fragmented approach impacts revenue cycles, delays patient access to care, and diverts valuable staff time from patient-facing activities, particularly for high-volume Medicaid and Medicare Advantage plans.

The Challenge: Greenway Health to Fidelis Care PA Workflows

Ambulatory practices using Greenway Health EMR, including Intergy and Prime Suite, frequently encounter bottlenecks when submitting prior authorization requests to Fidelis Care. Typical workflows involve manual data entry into the Fidelis Care provider portal or reliance on limited X12 278 transactions, leading to transcription errors and significant administrative overhead. This is particularly acute for Centene-owned Fidelis Care's extensive Medicaid and Medicare Advantage member base in New York.

Seamless Integration via Greenway Marketplace

Klivira integrates directly with your Greenway Health EMR, including both Intergy and Prime Suite, through the Greenway Marketplace. This certified integration enables direct initiation of prior authorization requests from your native EMR environment. By leveraging existing patient data within Greenway, Klivira eliminates manual data re-entry, ensures data accuracy, and reduces the administrative burden on your prior authorization coordinators.

Optimizing Key Fidelis Care PA Workflows for Greenway Users

**Specialty Medication ePA:** Automate prior authorization for high-cost specialty drugs frequently prescribed for Fidelis Care's Medicaid and Medicare populations, including biologics and complex injectables.
**Advanced Imaging Services:** Streamline precertification for services like MRIs, CT scans, and PET scans, which often require adherence to specific clinical criteria and RBM routing.
**Surgical and Procedure Authorizations:** Expedite prior authorization for common ambulatory surgical procedures and other high-cost interventions, reducing delays in scheduling.
**Durable Medical Equipment (DME):** Automate PA submissions for DME items, ensuring timely approval for necessary patient equipment.
**Behavioral Health Services:** Address the unique PA requirements for mental health and substance use disorder treatments, a critical area for Medicaid plans.

Targeted Automation for High-Volume Fidelis Care Services

Klivira's platform is designed to manage the specific prior authorization requirements of Fidelis Care, a significant payer in New York with a strong focus on Medicaid and Medicare. We provide targeted automation for medication classes such as GLP-1 agonists, certain immunomodulators, and high-cost mental health medications. Additionally, Klivira streamlines the authorization process for advanced diagnostic imaging and outpatient surgical procedures, aligning with Fidelis Care's clinical guidelines and submission protocols.

Enhanced Compliance and Data Security

Klivira operates with robust data security protocols, ensuring the protection of PHI and ePHI during all prior authorization transactions. Our platform facilitates compliance by standardizing submission processes and maintaining auditable records of all interactions. This reduces compliance risk and provides transparency for your practice when engaging with payers like Fidelis Care.

Frequently asked questions

How does Klivira connect to our Greenway Health EMR for Fidelis Care PAs?

Klivira integrates directly with your Greenway Health EMR (Intergy and Prime Suite) via the Greenway Marketplace. This enables secure, bi-directional data exchange, allowing your team to initiate and manage Fidelis Care prior authorizations directly from within your familiar EMR interface without manual data re-entry.

Which Fidelis Care plans are supported by Klivira's prior authorization automation?

Klivira supports prior authorization automation for all Fidelis Care plans, including their Medicaid Managed Care, Medicare Advantage, and Essential Plan offerings in New York. As a Centene-owned entity, Fidelis Care's PA requirements are continuously monitored and updated within our system.

Can Klivira handle specialty drug prior authorizations for Fidelis Care?

Yes, Klivira is specifically designed to manage complex specialty drug prior authorizations for payers like Fidelis Care. Our system automates the submission of necessary clinical documentation and leverages ePA pathways to expedite approvals for high-cost medications, including those for chronic conditions prevalent in Medicaid and Medicare populations.

Does Klivira assist with imaging prior authorizations for Fidelis Care patients?

Absolutely. Klivira streamlines the prior authorization process for advanced imaging services, such as MRIs, CTs, and PET scans, for Fidelis Care members. Our platform helps ensure that all required clinical criteria and documentation are submitted accurately, reducing delays in diagnostic scheduling.

How does Klivira ensure the security of patient data with Greenway and Fidelis Care?

Klivira adheres to stringent HIPAA-compliant security protocols to protect all PHI and ePHI exchanged between your Greenway Health EMR and Fidelis Care. We employ advanced encryption, access controls, and regular security audits to safeguard sensitive patient information throughout the prior authorization lifecycle.