Streamlining Prior Authorizations with MatrixCare Surescripts Integration

Klivira accelerates specialty drug prior authorizations by seamlessly integrating with MatrixCare, leveraging the Surescripts ePA platform to streamline workflows for long-term and post-acute care providers.

For revenue cycle directors and prior authorization coordinators in long-term care, home health, and hospice settings, managing specialty drug PAs within MatrixCare presents significant administrative burdens. Klivira's targeted integration addresses these challenges by automating the Surescripts ePA process, reducing manual effort and accelerating approval times.

Klivira's Architectural Approach to MatrixCare Surescripts Integration

Klivira connects directly with ResMed MatrixCare through its robust API framework, establishing a secure conduit for patient and prescription data. This integration allows for the initiation of Surescripts ePA requests directly from relevant clinical contexts within MatrixCare, such as medication order entry or patient profiles, eliminating the need for duplicate data entry.

Enhanced Workflow for MatrixCare Users

Automated data extraction: Patient demographics, diagnoses (ICD-10), and medication orders (NDC, RxCUI) are pulled directly from MatrixCare.
Contextual ePA initiation: Prior authorization requests for specialty drugs can be triggered from MatrixCare's medication management screens.
Surescripts ePA submission: Klivira translates MatrixCare data into NCPDP SCRIPT standards for submission via the Surescripts network.
Real-time status updates: Track the progress of ePA requests, including X12 278 responses, directly within the Klivira platform, accessible to MatrixCare users.
Documentation support: Relevant clinical notes and justifications from MatrixCare's documentation templates can be attached to ePA submissions.

Optimizing Data Exchange for Specialty Drug PAs

The integration leverages MatrixCare's exposed data elements for comprehensive ePA submissions. Klivira augments this by retrieving payer-specific formulary requirements, coverage rules, and medical necessity criteria from various payer portals, consolidating all necessary information for a complete Surescripts ePA submission. This minimizes information gaps that often lead to denials and appeals.

Addressing Long-Term Care Prior Authorization Challenges

The unique demands of long-term care, home health, and hospice require a prior authorization solution that understands complex medication regimens and transitions of care. Klivira's MatrixCare Surescripts integration is designed to manage these complexities, ensuring that residents and patients receive timely access to essential specialty medications without administrative delays.

Compliance and Data Security Considerations

All data exchanges between MatrixCare, Klivira, and the Surescripts network adhere to stringent HIPAA guidelines for PHI protection. Organizations should review their existing data sharing agreements and consult with their compliance teams to ensure alignment with all relevant privacy and security protocols when implementing automated ePA solutions.

Frequently asked questions

How does Klivira integrate with MatrixCare for Surescripts ePA?

Klivira utilizes the MatrixCare API framework to securely extract necessary patient and prescription data. This data is then formatted to NCPDP SCRIPT standards for submission through the Surescripts ePA network, streamlining the prior authorization process directly from your existing EMR environment.

What specific data does Klivira pull from MatrixCare for ePA?

Klivira pulls key data points such as patient demographics, active diagnosis codes (ICD-10), medication orders including NDC and RxCUI, and prescribing provider information. This ensures that all essential clinical and administrative data required for a comprehensive ePA submission is captured.

Can I track the status of a Surescripts ePA request within MatrixCare?

While the primary tracking interface is within the Klivira platform, Klivira provides a consolidated view of ePA statuses, including responses from the Surescripts network (e.g., X12 278 transactions). This allows prior authorization coordinators to monitor progress without navigating multiple systems.

Is this integration suitable for all types of medications in MatrixCare?

This integration is specifically optimized for specialty drug prior authorizations, leveraging the Surescripts ePA platform's capabilities for these complex medications. While it can process various PAs, its core strength lies in streamlining the often-burdensome specialty drug approval process within long-term care.

What are the benefits for long-term care facilities using MatrixCare?

Benefits include reduced manual administrative tasks for prior authorization coordinators, accelerated turnaround times for specialty drug approvals, lower denial rates due to comprehensive data submission, and improved patient access to critical medications within long-term care, home health, and hospice settings.