Streamlining Tebra CGM Prior Auth with Klivira

Klivira directly integrates with Tebra (formerly Kareo and PatientPop) to automate the entire Tebra CGM prior auth process, reducing administrative burden for small to mid-sized independent practices.

Revenue cycle directors and prior authorization coordinators at independent practices leveraging Tebra face unique challenges in securing timely approvals for Continuous Glucose Monitors (CGMs). Manual processes for Dexcom and Libre prior authorizations within the Tebra EHR can lead to delays, increased denial rates, and staff burnout. Klivira provides a purpose-built solution to integrate and automate these critical workflows.

Seamless Integration with Tebra's Platform for CGM Authorizations

Klivira leverages the Tebra API to establish a secure, bi-directional data exchange for CGM prior authorizations. This integration allows Klivira to pull necessary patient and clinical data directly from the Tebra EHR, initiating the prior authorization process without requiring manual data entry into external portals.

Optimizing CGM Prior Authorization Data Flow from Tebra

**Patient Demographics:** Klivira extracts core patient information from Tebra's patient charts.
**Diagnosis Codes:** Automated retrieval of ICD-10 codes (e.g., E10, E11 for diabetes mellitus) from Tebra's problem list.
**Medication History:** Access to current and historical insulin and other diabetes-related prescriptions documented within Tebra.
**Clinical Documentation:** Pulling relevant clinical notes, lab results (e.g., A1C), and provider attestations regarding insulin dependence or previous CGM use directly from Tebra encounter screens.
**Provider Information:** Secure transfer of ordering and rendering provider NPIs and practice details from Tebra's provider directories.

Automating the CGM Authorization Workflow within Tebra

When a provider orders a CGM (such as Dexcom or Libre) within Tebra's EHR, Klivira's integration automatically detects the need for prior authorization. Clinical staff can initiate the authorization request directly from the patient's chart or order entry screen, leveraging pre-populated data from Tebra to build a comprehensive submission package for the payer.

Comprehensive Support for CGM Authorization and Re-authorization

Klivira supports both initial CGM authorizations and subsequent supply re-authorizations for patients managed within Tebra. Our platform intelligently tracks authorization expiry dates and proactively prompts for re-authorization, ensuring continuous access to essential diabetes management tools for your patients without workflow interruptions.

Enhancing Compliance and Efficiency for Tebra Users

By automating the Tebra CGM prior auth process, Klivira helps practices maintain compliance with payer-specific medical policies and CMS guidelines (e.g., CMS-0057-F for ePA). This reduces the risk of denials due to incomplete documentation and frees up valuable staff time, allowing your prior authorization coordinators to focus on complex cases rather than manual data entry.

Frequently asked questions

How does Klivira integrate with Tebra for CGM prior authorizations?

Klivira integrates directly with Tebra via its robust API. This allows for secure, real-time exchange of patient demographics, clinical documentation, diagnosis codes, and order details necessary to initiate and manage CGM prior authorization requests without manual data transcription.

What specific CGM data does Klivira pull from Tebra for Dexcom or Libre authorizations?

Klivira pulls essential data points including patient demographics, ICD-10 codes for diabetes, medication lists (especially insulin), A1C lab results, and clinical notes detailing insulin dependence, frequency of glucose monitoring, and previous CGM use, all directly from the Tebra EHR.

Does Klivira handle re-authorization workflows for CGM supplies within Tebra?

Yes, Klivira fully supports CGM supply re-authorization workflows. Our system tracks authorization expiration dates and facilitates the submission of renewal requests, ensuring continuous coverage for patients using Dexcom, Libre, or other continuous glucose monitors.

Is PHI secure when integrating Klivira with Tebra for prior authorizations?

Absolutely. Klivira adheres to stringent security protocols, including HIPAA compliance, to ensure the protection of all PHI exchanged with Tebra. Data transmission occurs over secure, encrypted channels, safeguarding patient privacy throughout the prior authorization process.

Can Klivira adapt to different payer requirements for CGM prior authorizations for Tebra users?

Yes, Klivira's platform is designed to adapt to the diverse and often complex medical policies of various payers for CGM authorizations. We leverage a comprehensive rules engine that incorporates payer-specific requirements, ensuring that submissions from Tebra provide all necessary documentation for approval.