Optimizing Prior Authorizations with Greenway Health and Cognizant TriZetto

The Greenway Health EMR Ecosystem and Prior Authorization

Greenway Health, through its Intergy and Prime Suite platforms, is a cornerstone EMR for numerous ambulatory practices. While these systems provide robust clinical and billing functionalities, prior authorization workflows often remain a manual, fragmented process, requiring staff to navigate between the EMR, payer portals, and clearinghouse interfaces. Klivira integrates directly with Greenway Health to unify this process.

Cognizant TriZetto: A Central Hub for Payer Connectivity

Cognizant TriZetto serves as a critical intermediary in the healthcare revenue cycle, facilitating claims submission, eligibility verification, and increasingly, prior authorization requests. As a comprehensive clearinghouse and payer platform, TriZetto connects providers to a vast network of payers, making it a central point for administrative transactions. Optimizing the flow of PA data through this hub is paramount for efficiency.

Klivira's Integration Approach: Greenway Health to Cognizant TriZetto

Klivira leverages the Greenway Marketplace for secure and compliant data exchange, establishing a seamless connection between Greenway Health EMRs and the Cognizant TriZetto platform. Our integration strategy focuses on extracting clinical and demographic data directly from Greenway's Intergy or Prime Suite, then orchestrating the submission of prior authorization requests via TriZetto's established payer connections, or directly to payer portals as needed. This approach minimizes manual data entry and reduces the potential for errors.

Streamlined Prior Authorization Workflow within Greenway Health

• Initiation of a prior authorization request directly from the patient's chart in Greenway Intergy or Prime Suite, often triggered by an order for a procedure, medication, or imaging study.
• Klivira's intelligent engine automatically identifies required PA based on payer rules and service codes, pulling relevant patient demographics, diagnoses (ICD-10), and procedure codes (CPT/HCPCS) from the EMR.
• Clinical documentation pertinent to the PA is extracted from the patient's record within Greenway, including progress notes, lab results, and imaging reports, ensuring comprehensive submission.
• The Klivira platform then formats and transmits the PA request, leveraging Cognizant TriZetto's clearinghouse capabilities for submission via X12 278, ePA, or direct portal submission where applicable.
• Real-time status updates and payer responses are pushed back into the Greenway Health EMR, providing transparency and reducing the need for staff to log into external systems.
• Automated alerts within Greenway notify PA coordinators of pending requests, denials, or requests for additional information.

Data Exchange and Compliance Considerations

Greenway Health EMRs expose critical data points for prior authorization, including patient demographics, insurance information, clinical notes, diagnoses, and ordered services. Klivira securely ingests this ePHI, supplementing it with payer-specific requirements and clinical criteria derived from our extensive rules engine. Our platform ensures that data transmitted through Cognizant TriZetto or directly to payers adheres to HIPAA standards and industry best practices for secure data exchange, such as X12 278 and NCPDP SCRIPT for pharmacy PAs. Organizations should review their specific data sharing agreements with their compliance teams.

Maximizing Efficiency and Reducing Denials

By automating the prior authorization process from Greenway Health through Cognizant TriZetto, Klivira significantly reduces the administrative burden on your staff. This efficiency translates into faster turnaround times for approvals, fewer manual errors, and a proactive approach to managing payer requirements. The result is a substantial reduction in PA-related denials and improved cash flow for your ambulatory practice.