Greenway Health Medicare Prior Authorization Automation

Ambulatory practices utilizing Greenway Health EMRs face unique challenges in managing Medicare prior authorizations. Klivira delivers precise Greenway Health Medicare prior authorization automation, streamlining submissions to MACs and Part D plans.

For revenue cycle directors and PA coordinators at ambulatory practices, navigating Medicare's specific prior authorization requirements from within Greenway Health (Intergy or Prime Suite) can be a source of significant administrative burden. While Original Medicare's PA scope is limited, the need for accurate, jurisdiction-specific submissions and efficient Part D pharmacy PA remains critical. Klivira addresses these operational complexities, integrating directly with your Greenway environment.

Navigating Medicare Prior Authorization Workflows within Greenway Health

Traditional Medicare (Parts A and B) prior authorization, where applicable, routes through specific Medicare Administrative Contractors (MACs) such as Noridian, NGS, WPS, Palmetto, FCSO, and Novitas. For practices using Greenway Health, this often means manual processes to determine the correct MAC jurisdiction, access their unique portals, and track specific program requirements like those for DME or certain outpatient services. This fragmented approach disrupts clinical workflows and can lead to delays.

Klivira's Seamless Integration with Greenway Health EMRs

Klivira integrates directly with Greenway Health EMRs like Intergy and Prime Suite, leveraging the Greenway Marketplace for secure data exchange. This integration enables Klivira to pull necessary patient demographics, clinical documentation, and order details directly from the patient chart, eliminating redundant data entry. By embedding prior authorization initiation within the existing EMR workflow, Klivira reduces manual effort and improves data accuracy for Medicare submissions.

Supported Medicare Prior Authorization Programs and Channels

**MAC-Aware Routing:** Klivira routes medical (Part A and B) prior authorizations to the correct MAC based on the provider's jurisdiction, supporting programs like Outpatient Department services PA and Repetitive Scheduled Non-Emergent Ambulance Transport PA.
**DME Prior Authorization:** Automation for Durable Medical Equipment (DME) PA, including items covered under the PMD demonstration and expanded lists.
**Home Health & Hospice:** Prior authorization and notification for specific home health, hospice, and post-acute services.
**Medicare Part D Pharmacy PA:** Klivira supports electronic prior authorization (ePA) for Part D medications, routing requests to the appropriate commercial insurers operating as private contractors for Part D plans.
**Policy Adherence:** Klivira incorporates logic for CMS National Coverage Determinations (NCDs) and MAC Local Coverage Determinations (LCDs), ensuring submissions align with current utilization management policies.

Optimizing Medicare Part D Pharmacy Prior Authorizations

While Original Medicare's medical PA scope is limited, Medicare Part D plans, administered by private insurers, frequently require prior authorization for specific pharmacy benefits. Klivira's platform automates the submission of Part D pharmacy prior authorizations, leveraging ePA channels and supporting the specific formularies and step-therapy protocols approved by CMS. This reduces the administrative burden on ambulatory practices when prescribing medications covered under Part D.

Enhancing Compliance with NCDs and LCDs

Adherence to Medicare's coverage policies, including CMS-published National Coverage Determinations (NCDs) and MAC-published Local Coverage Determinations (LCDs), is paramount. Klivira embeds these policy requirements into its automation logic, prompting for necessary documentation and ensuring that prior authorization requests are submitted with the correct clinical evidence. This proactive approach helps reduce denials and ensures compliance with specific NCD numbers and LCD IDs relevant to the service or item.

Frequently asked questions

How does Klivira handle the limited prior authorization scope for Original Medicare?

Klivira focuses on the specific services and programs where Original Medicare requires prior authorization, such as DME, certain outpatient services, and specific home health/hospice services. For these, Klivira automates routing to the correct Medicare Administrative Contractor (MAC) and applies NCD/LCD-aware policy logic to ensure compliant submissions.

What data does Klivira pull from Greenway Health for Medicare PA requests?

Klivira integrates with Greenway Health via the Greenway Marketplace to securely extract essential patient data. This includes demographics, diagnoses, procedure codes, relevant clinical notes, and order details, ensuring that prior authorization requests are pre-populated with accurate and comprehensive information directly from the EMR.

Does Klivira support prior authorizations for Medicare Part D prescriptions?

Yes, Klivira fully supports prior authorizations for Medicare Part D pharmacy benefits. We automate the submission of ePA requests to the commercial insurers who administer Part D plans, helping practices navigate plan-specific formularies and step-therapy requirements efficiently.

How does Klivira manage prior authorizations for different Medicare Administrative Contractors (MACs)?

Klivira's system is designed with MAC-aware routing capabilities. It identifies the appropriate MAC (e.g., Noridian, NGS, WPS) based on the provider's jurisdiction and ensures that prior authorization requests for medical services are submitted through the correct channel, adhering to each MAC's specific operational guidelines and LCDs.

Is Klivira's integration with Greenway Health secure and HIPAA compliant?

Yes, Klivira prioritizes the security and privacy of protected health information (PHI). Our integration with Greenway Health via the Greenway Marketplace adheres to industry best practices and is designed to be HIPAA compliant, ensuring secure data exchange and processing of prior authorization requests.