Streamlining MatrixCare Naviguard Prior Authorizations for LTC Providers

Klivira directly integrates with MatrixCare to automate UnitedHealthcare Naviguard prior authorizations, simplifying a critical workflow for long-term care, home health, and hospice providers.

Revenue cycle directors and prior authorization coordinators in long-term care settings face unique challenges managing utilization management for payers like UnitedHealthcare Naviguard. Manual processes within EMRs like MatrixCare lead to delays, increased administrative burden, and potential revenue loss. Klivira addresses this by providing a targeted automation solution.

Navigating UnitedHealthcare Naviguard within MatrixCare Workflows

For organizations leveraging ResMed MatrixCare for long-term care, home health, or hospice, managing UnitedHealthcare Naviguard utilization management can be a significant administrative burden. Providers often grapple with extracting necessary clinical data from MatrixCare and manually submitting it to Naviguard, leading to fragmented workflows and potential authorization delays.

Klivira's Integration with MatrixCare for Naviguard Automation

Klivira automates the Naviguard prior authorization process by integrating directly with MatrixCare via its robust APIs. This connection enables seamless data extraction from MatrixCare's patient charts, order entry points, and clinical documentation, eliminating the need for manual data re-entry into payer portals or external systems. The result is a streamlined workflow that initiates and tracks Naviguard PAs without disrupting core EMR operations.

Key Data Points Exchanged for Naviguard Prior Authorizations

Patient demographics and insurance information from MatrixCare's patient profiles.
Diagnosis codes (ICD-10) and supporting medical necessity documentation from clinical notes and assessments.
Ordered services, procedures, and medications from MatrixCare's order entry and medication management modules.
Care plan details, anticipated duration of services, and justification for skilled care.
Authorization status updates, authorization numbers, and denial reasons, which Klivira pulls from Naviguard and can update within MatrixCare.
Clinical documentation and attachments required for comprehensive utilization review.

Leveraging MatrixCare APIs for Efficient Data Flow

Our solution utilizes MatrixCare's secure and structured APIs to facilitate the automated exchange of PHI necessary for Naviguard prior authorization requests. This direct API integration ensures data integrity and security, enabling Klivira to automatically prepare and submit X12 278 transactions or ePA requests to Naviguard, reducing the risk of errors associated with manual processes and accelerating the entire authorization lifecycle.

Operational Benefits for MatrixCare Users in Post-Acute Care

Automating UnitedHealthcare Naviguard prior authorizations through Klivira provides tangible benefits for MatrixCare users in long-term care, home health, and hospice. Organizations can expect a significant reduction in administrative overhead, faster turnaround times for critical authorizations, and improved compliance with UHC's specific requirements. This allows clinical staff to focus more on patient care and less on burdensome paperwork, optimizing resource allocation and enhancing revenue cycle integrity.

Frequently asked questions

How does Klivira integrate with MatrixCare for Naviguard prior authorizations?

Klivira integrates directly with MatrixCare using its robust APIs. This connection allows Klivira to securely extract necessary patient demographics, clinical data, and ordered services from MatrixCare to automatically generate and submit UnitedHealthcare Naviguard prior authorization requests.

What specific MatrixCare data does Klivira use for Naviguard submissions?

Klivira pulls essential data such as patient demographics, ICD-10 diagnosis codes, ordered procedures or services, and supporting clinical documentation from various sections within MatrixCare, including patient charts, order entry, and clinical notes, to fulfill Naviguard's submission requirements.

Can Klivira track Naviguard PA status updates directly within MatrixCare?

Yes, Klivira monitors the status of Naviguard prior authorization requests. While direct write-back into specific MatrixCare fields depends on API capabilities, Klivira provides real-time status updates, authorization numbers, and denial reasons, which can be accessed by your team to inform MatrixCare documentation.

Is this integration applicable to all MatrixCare modules, including home health and hospice?

The integration is designed to support the specific data requirements for prior authorizations across MatrixCare's core segments, including long-term care, home health, and hospice. Klivira leverages the available MatrixCare APIs to access relevant data points regardless of the specific module where the information resides.

How does automating Naviguard PAs impact our revenue cycle in MatrixCare?

Automating Naviguard PAs significantly improves your revenue cycle by reducing manual errors, accelerating authorization approvals, and minimizing claim denials. This leads to faster reimbursement, decreased administrative costs, and a more predictable revenue stream for MatrixCare users.