Optimizing Iatric Systems Anthem (Elevance Health) Prior Authorization Automation

Klivira streamlines Iatric Systems Anthem (Elevance Health) prior authorization automation, reducing manual effort and accelerating decision times for complex medical and pharmacy benefit requests.

Revenue cycle leaders and prior authorization coordinators face significant challenges managing diverse payer requirements directly from their EMRs. Integrating Iatric Systems with Anthem's varied submission channels, from Availity to Carelon MBM, often involves fragmented workflows and potential delays. Klivira provides a unified solution to bridge these gaps, ensuring compliant and efficient prior authorization processing.

Integrating Iatric Systems with Anthem's Diverse Channels

Klivira leverages the Iatric integration suite to connect directly with your existing hospital systems, extracting necessary clinical and demographic data. This integration eliminates the need for manual data re-entry into separate payer portals, establishing a seamless flow from Iatric Systems for all Anthem (Elevance Health) prior authorization submissions.

Navigating Anthem's Multi-Channel Prior Authorization Landscape

Anthem, operating under Elevance Health, utilizes a complex ecosystem for prior authorizations. Klivira's platform is engineered to interact with these distinct channels, ensuring that each request is routed correctly and efficiently, whether it's for medical, pharmacy, or specialty services.

Optimized Submission Pathways

**Availity Essentials:** Automated submission and status tracking for standard medical benefit PAs, including inpatient admission notifications and concurrent reviews.
**X12 278 Transactions:** Support for electronic submission and receipt of prior authorization requests and responses via clearinghouses.
**Carelon Medical Benefits Management (formerly AIM Specialty Health):** Direct integration for services like advanced imaging, cardiology, MSK, sleep, and radiation oncology, bypassing manual portal interactions.
**ePA Partners (CoverMyMeds, Surescripts):** Streamlined pharmacy benefit prior authorizations through CarelonRx's preferred electronic channels.
**Carelon Behavioral Health:** Facilitated submission for behavioral health services, verifying specific carve-out or in-network handling per line of business and state.

Streamlining Policy Adherence and Clinical Documentation

Accurate policy adherence is critical for Anthem (Elevance Health) prior authorizations. Klivira assists by structuring clinical documentation from Iatric Systems to align with Anthem's medical policies and Carelon MBM's clinical guidelines. This proactive approach helps address common denial categories such as medical necessity, site-of-service mismatch, and step therapy requirements.

Accelerating Decision Turnaround and Compliance

Beyond submission, Klivira helps manage the lifecycle of Anthem prior authorizations, assisting providers in meeting state-specific commercial PA timeframes and payer-published service-level targets. For Medicare Advantage, Medicaid, CHIP, and QHP-on-FFM lines, Klivira supports compliance with CMS-0057-F mandates for 72-hour standard and 24-hour expedited decision timeframes.

Addressing Complex Specialty Workflows

Many Anthem plans leverage Carelon Medical Benefits Management for specialty services, requiring distinct workflows and policy access. Klivira specifically addresses these complexities, ensuring that requests for advanced imaging, MSK procedures, or high-cost specialty drugs are routed to the correct Carelon portal with the necessary documentation, reducing re-work and delays.

Frequently asked questions

How does Klivira handle prior authorizations for specialty services like advanced imaging with Anthem?

For services such as advanced imaging, cardiology, and MSK, Anthem (Elevance Health) routes prior authorizations through Carelon Medical Benefits Management. Klivira automates submissions directly to the Carelon MBM provider portal, ensuring that the specific clinical guidelines and submission requirements for these domains are met without manual intervention.

Can Klivira integrate with my Iatric Systems EMR to pull patient data for Anthem PAs?

Yes, Klivira integrates with your Iatric Systems via its robust integration suite. This allows for direct extraction of relevant patient demographics, clinical notes, and order details, significantly reducing manual data entry and ensuring data accuracy for Anthem prior authorization requests.

What are the primary channels Klivira uses to submit prior authorizations to Anthem?

Klivira connects to Anthem (Elevance Health) through multiple channels. This includes automating submissions via Availity Essentials for general medical PAs, supporting X12 278 transactions, integrating directly with Carelon Medical Benefits Management for specialty services, and leveraging ePA partners like CoverMyMeds and Surescripts for pharmacy benefits.

Does Klivira help with compliance for CMS-0057-F with Anthem's Medicare Advantage plans?

Yes, Klivira supports compliance with CMS-0057-F for Anthem's Medicare Advantage, Medicaid, CHIP, and QHP-on-FFM plans. Our platform helps manage the prior authorization workflow to align with the mandated 72-hour standard and 24-hour expedited decision timeframes, contributing to timely processing and reduced administrative burden.

How does Klivira manage the different medical policies and clinical guidelines for Anthem?

Klivira's system is designed to navigate Anthem's varied policy landscape. For general medical PAs, it helps align documentation with Anthem's state-specific medical policies accessed via Availity. For services under Carelon Medical Benefits Management, it directs users to the specific guidelines published on the Carelon MBM provider site, ensuring correct criteria application.