Optimizing PointClickCare Peer-to-Peer Scheduling Workflows

Klivira automates PointClickCare peer-to-peer scheduling, transforming a manual, time-consuming process into an efficient workflow for long-term care and senior living facilities.

For revenue cycle directors and prior authorization coordinators in PointClickCare-centric organizations, managing peer-to-peer (P2P) reviews after a prior authorization denial is a significant operational challenge. These critical calls, often required for clinical necessity disagreements, demand precise coordination between clinicians, payers, and documentation — a process prone to delays and clinician burnout.

The Challenge of Manual Peer-to-Peer Scheduling in Long-Term Care

In long-term care and skilled nursing facilities (SNFs) utilizing PointClickCare, complex patient cases frequently lead to prior authorization denials based on clinical necessity. Manually coordinating P2P reviews involves extensive administrative effort: reconciling clinician calendars with payer medical director availability, preparing comprehensive documentation, and tracking outcomes. This manual burden contributes to clinician burnout and can delay access to necessary care, as highlighted by industry benchmarks like the AMA prior authorization physician survey.

Klivira's Automated P2P Workflow for PointClickCare Environments

Klivira integrates with PointClickCare via its robust APIs to automate the entire peer-to-peer scheduling process. Our platform detects P2P-eligible denials, streamlines calendar coordination, and ensures clinicians are fully prepared, all while leveraging the rich patient data housed within PointClickCare. This integration minimizes manual touchpoints for PA coordinators and ordering clinicians within long-term care settings.

Key Steps in Klivira's P2P Automation with PointClickCare

**Auto-detection of P2P-Eligible Denials:** Klivira's denial-router identifies cases requiring peer-to-peer review, distinguishing them from other denial paths.
**Payer-Side Window Discovery:** Klivira ingests payer P2P availability or initiates requests via payer portals/mechanisms to capture available time slots.
**Clinician-Calendar Integration:** The platform reads the ordering clinician's calendar via FHIR Appointment resource (where supported) or integrated calendar systems, proposing optimal mutual windows.
**Automated Pre-Call Packet Assembly:** Klivira pulls relevant clinical notes, prior-line therapy, lab/imaging results, and peer-reviewed literature from PointClickCare APIs to create a structured clinical packet for the clinician.
**Reminders and Outcome Capture:** Automated reminders are sent to clinicians with attached packets. Post-call, Klivira captures outcomes via structured forms, routing them into PointClickCare as DocumentReference and Communication writes, and triggering downstream workflows.
**P2P Pattern Analytics:** Klivira analyzes P2P success patterns by denial reason, payer, and clinician, providing actionable insights to improve upstream prior authorization submissions.

Addressing Specific P2P Bottlenecks for PointClickCare Users

Klivira's automation directly targets the critical failure modes experienced by PointClickCare users in long-term care. We eliminate the clinician calendar availability bottleneck by proposing mutually available times, reduce three-way scheduling friction, and prevent missed P2P windows through automated reminders. Crucially, automated documentation assembly from PointClickCare APIs ensures clinicians have all necessary information, reducing pre-call prep time and improving call efficacy.

Technical Integration: Leveraging PointClickCare APIs for Data Exchange

Klivira securely integrates with PointClickCare through its established APIs. This allows for the extraction of specific, consented patient data — such as clinical notes, medication history, and diagnostic results — essential for building comprehensive pre-call packets. Post-P2P review, Klivira writes back the outcome directly into the patient's record within PointClickCare, ensuring a complete and auditable trail for compliance and continuity of care. This structured data exchange underpins the efficiency of the automated P2P workflow.

Frequently asked questions

How does Klivira integrate with PointClickCare for P2P scheduling?

Klivira integrates with PointClickCare via its robust APIs. This allows our platform to securely access relevant patient data for pre-call documentation and to write back P2P outcomes directly into the patient's record within PointClickCare, complementing existing workflows for long-term care providers.

What specific data does Klivira pull from PointClickCare for P2P reviews?

For peer-to-peer reviews, Klivira leverages PointClickCare APIs to pull essential clinical documentation. This includes clinical notes, prior-line therapy history, lab results, and imaging reports, which are then compiled into a comprehensive pre-call packet for the ordering clinician.

How does automated P2P scheduling impact clinicians using PointClickCare?

Automated P2P scheduling significantly reduces the administrative burden on clinicians. By streamlining calendar coordination and automating documentation prep, Klivira minimizes the time clinicians spend on non-clinical tasks related to prior authorizations, allowing them to focus more on patient care and reducing burnout, as observed in AMA surveys.

Can Klivira help with P2P scheduling for multiple payers in a PointClickCare environment?

Yes, Klivira's platform is designed to manage P2P scheduling across a wide array of payers. It ingests payer-specific availability windows and contact mechanisms, coordinating these with clinician calendars regardless of the payer, providing a centralized solution for PointClickCare users.

What kind of outcomes are tracked after a P2P call in Klivira?

After a peer-to-peer call, Klivira captures the outcome (e.g., approval, modification, upheld denial) via a structured form. This outcome is then automatically recorded in PointClickCare as a DocumentReference and Communication, ensuring consistent tracking and triggering appropriate downstream workflows like revised order entry or formal appeal processes.