Streamlining Prior Authorization with Greenway Health and Inovalon Clearinghouse

Klivira optimizes prior authorization workflows for ambulatory practices utilizing Greenway Health EMRs and routing claims through Inovalon Clearinghouse, ensuring seamless data exchange and accelerated approvals.

Revenue cycle leaders and prior authorization coordinators face increasing complexity in managing PAs, especially when disparate systems like an EMR and a clearinghouse are involved. Integrating Greenway Health with Inovalon Clearinghouse for PA processes requires precise data orchestration to minimize denials and improve turnaround times.

The Intersection of Greenway Health and Inovalon Clearinghouse in PA Workflows

For ambulatory practices leveraging Greenway Health's Intergy or Prime Suite EMRs and processing claims via Inovalon Clearinghouse, prior authorization often presents a manual bottleneck. Klivira's platform integrates directly into this ecosystem, automating the PA lifecycle from order initiation in Greenway to final authorization, complementing Inovalon's clearinghouse functions by securing necessary approvals upstream.

Key Data Elements Klivira Leverages from Greenway Health EMRs

Patient demographics and insurance details
Ordered services (CPT/HCPCS codes)
Diagnostic codes (ICD-10)
Rendering and referring provider NPIs
Relevant clinical documentation (e.g., progress notes, lab results, imaging reports)

Initiating Prior Authorization within Greenway Intergy and Prime Suite

Prior authorization requests typically originate when a physician places an order for a service, medication, or procedure within Greenway Intergy or Prime Suite. Klivira integrates at this critical point, capturing the necessary order and patient data directly from the EMR. This proactive approach ensures that PA requests are initiated early in the workflow, leveraging existing clinical templates and order sets to gather supporting documentation efficiently.

Klivira's Integration via Greenway Marketplace for Inovalon Workflows

Klivira connects with Greenway Health EMRs through the Greenway Marketplace, utilizing secure APIs to facilitate compliant data exchange. This integration surface allows Klivira to securely extract patient, order, and clinical data from Intergy or Prime Suite, transforming it into structured formats required for ePA (e.g., X12 278, NCPDP SCRIPT) and payer portal submissions. This seamless data flow supports efficient claim processing through Inovalon by ensuring PAs are secured upfront.

Klivira's Complementary Data and Automation for Inovalon-Routed PAs

Payer-specific authorization requirements (e.g., Da Vinci PAS, CMS-0057-F)
Real-time status updates from payer portals and ePA transactions
Automated clinical document submission and follow-up
Intelligent denial prediction and appeal support
Comprehensive analytics on PA performance and denial trends

Enhancing Revenue Cycle Efficiency for Ambulatory Practices

By automating the prior authorization process between Greenway Health and the Inovalon Clearinghouse workflow, Klivira significantly reduces administrative burden for ambulatory practices. This integration leads to faster PA approvals, fewer PA-related denials, and improved claim readiness, ultimately enhancing revenue cycle efficiency and financial outcomes by ensuring that authorized services proceed without unnecessary delays.

Frequently asked questions

How does Klivira access patient data from Greenway Health for prior authorizations?

Klivira integrates with Greenway Health EMRs (Intergy, Prime Suite) through the Greenway Marketplace, utilizing secure APIs to extract necessary patient demographics, insurance information, ordered services, and relevant clinical documentation. This ensures compliant and efficient data transfer for PA requests, adhering to HIPAA guidelines.

Can Klivira determine if a service requires prior authorization before a claim goes to Inovalon?

Yes, Klivira's intelligent engine ingests payer-specific rules and medical policies. Upon an order being placed in Greenway, Klivira can proactively identify if a prior authorization is required for that specific service, payer, and patient, well before the claim is prepared for Inovalon Clearinghouse.

How does Klivira handle updates or changes to a PA request originating in Greenway?

Klivira maintains a bidirectional sync where technically feasible. If an order is modified or additional clinical documentation is added in Greenway (Intergy or Prime Suite) that impacts an active PA, Klivira can identify these changes and facilitate updates to the payer via ePA channels or payer portals.

What is the role of Inovalon Clearinghouse in this integrated prior authorization workflow?

While Klivira manages the prior authorization communication with payers, Inovalon Clearinghouse handles the ultimate submission of the claim. Klivira ensures that the necessary authorization is secured and attached to the claim data originating from Greenway, facilitating a cleaner claim submission through Inovalon and reducing rejections related to missing or invalid PAs.

Does Klivira integrate with both Greenway Intergy and Prime Suite?

Yes, Klivira's integration capabilities through the Greenway Marketplace are designed to support both Greenway Intergy and Prime Suite platforms, providing consistent prior authorization automation across Greenway Health's ambulatory EMR portfolio.