MatrixCare Fax & Paper Form Automation: Streamlining PA Workflows

Klivira provides a robust solution for MatrixCare fax & paper form automation, directly addressing the manual burden of prior authorizations for long-term care, home health, and hospice providers.

Revenue cycle directors and prior authorization coordinators frequently encounter payers that still mandate fax or proprietary paper form submissions, even when utilizing a modern EMR like MatrixCare. This manual process diverts valuable staff time from patient care and introduces potential for errors and delays. Klivira automates these long-tail payer fax workflows by integrating directly with your ResMed MatrixCare environment.

Leveraging MatrixCare APIs for Prior Authorization Data

Klivira integrates with MatrixCare via its established APIs to securely extract the necessary clinical and administrative data required for prior authorization submissions. This direct connection ensures data accuracy and eliminates the need for manual transcription from various MatrixCare modules, forming the foundation for efficient fax and paper form automation.

Key Data Elements Automated from MatrixCare

Patient demographics (e.g., name, DOB, insurance ID) from the patient chart.
ICD-10 diagnoses and associated problem lists from the clinical record.
Ordered services, procedures, and medications (CPT/HCPCS codes, drug names) from order entry and medication administration records.
Relevant clinical notes, assessments (e.g., MDS for skilled nursing, OASIS for home health), and treatment plans supporting medical necessity.
Provider information and facility details from the organizational master data.

Seamless Workflow Integration within MatrixCare

While the automation occurs on the Klivira platform, the initiation point for prior authorization can be seamlessly integrated into existing MatrixCare workflows. For instance, a prior authorization request can be triggered from the 'Orders' module when a new service is entered, or from the 'Patient Chart' when a care plan requires authorization, ensuring staff can continue working within familiar MatrixCare screens.

Automating Long-Tail Payer Fax Workflows

For payers that do not support X12 278 or ePA via NCPDP SCRIPT, Klivira's platform ingests the extracted MatrixCare data and intelligently maps it onto payer-specific fax forms. This includes proprietary PDF templates and other paper-based requirements. The system then automatically populates these forms and manages secure fax transmission, providing digital confirmation of submission.

Operational Impact for MatrixCare Users

Implementing Klivira's MatrixCare fax & paper form automation significantly reduces the administrative burden on prior authorization coordinators and clinical staff. By automating data extraction and form completion, teams can reallocate time from manual tasks to direct patient care and focus on complex cases, improving overall operational efficiency and staff satisfaction within long-term care, home health, and hospice settings.

Frequently asked questions

How does Klivira access patient data from our MatrixCare EMR?

Klivira utilizes secure, authorized integration with MatrixCare's APIs to pull necessary patient demographics, clinical data, and service codes. This ensures data integrity and adherence to secure data exchange protocols, avoiding manual data entry and potential errors.

Which specific MatrixCare modules are involved in this automation?

Our integration primarily interacts with data housed in the 'Patient Chart,' 'Orders,' 'Medication Administration Records (MAR),' and 'Assessments' modules within MatrixCare. This allows for comprehensive data capture needed for a complete prior authorization submission.

Does this solution handle all types of prior authorizations for MatrixCare users?

This solution specifically targets long-tail payer fax and paper form workflows where electronic prior authorization (ePA) or X12 278 transactions are not supported. It complements your existing ePA processes, ensuring comprehensive coverage for all payer requirements.

How does Klivira ensure the security and privacy of PHI from MatrixCare?

Klivira adheres to stringent security protocols, including HIPAA compliance, to protect PHI extracted from MatrixCare. Data is encrypted in transit and at rest, and access is strictly controlled, ensuring the privacy and security of patient information throughout the automation process.

Can we track the status of faxed prior authorizations initiated from MatrixCare?

Yes, Klivira provides a centralized dashboard to track the status of all prior authorization submissions, including those sent via fax. This offers visibility into submission times, delivery confirmations, and any subsequent payer communications, all linked back to the originating MatrixCare data.