Accelerate Practice EHR Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers robust Practice EHR Anthem (Elevance Health) prior authorization automation, directly addressing the complexities of ambulatory practice workflows and multi-channel payer requirements.

Small ambulatory practices utilizing Practice EHR face distinct challenges in managing prior authorizations for Anthem (Elevance Health) members. The need to navigate diverse submission channels, varying clinical guidelines, and tight turnaround times often strains administrative resources, impacting patient care access and revenue cycles. Klivira's platform bridges this gap, providing a purpose-built solution for efficient PA management.

Navigating Anthem's Multi-Channel Prior Authorization Landscape from Practice EHR

Practice EHR users must contend with Anthem's varied PA submission pathways, including Availity Essentials for medical PA, X12 278 transactions, and specialized portals like Carelon Medical Benefits Management for specific service lines. This fragmentation, coupled with the need to access state-specific medical policies, creates significant manual overhead for small ambulatory practices.

Klivira's Direct Integration with Practice EHR for Streamlined Workflows

Klivira integrates directly with Practice EHR via its robust APIs, enabling a seamless flow of patient demographics, clinical documentation, and order details. This direct connection eliminates manual data entry and reduces the risk of errors, ensuring that authorization requests are initiated accurately and efficiently from within your EMR.

Key Anthem (Elevance Health) Prior Authorization Submission Channels

Availity Essentials for commercial and Medicare Advantage medical PA, including inpatient admission notification and concurrent review intake.
X12 278 transactions via clearinghouses for impacted medical benefit procedures.
Carelon Medical Benefits Management portal for advanced imaging, cardiology, MSK, sleep, and radiation oncology.
CoverMyMeds and Surescripts ePA for retail pharmacy benefit requests through CarelonRx.
Carelon Behavioral Health for specific behavioral health services, where applicable based on line of business and state.

Accessing Utilization Management Policies and Clinical Criteria

Klivira streamlines access to Anthem's utilization management policies, which are published through provider sites accessible via Availity, alongside state-specific Medicaid and MA variants. For domains managed by Carelon Medical Benefits Management (formerly AIM Specialty Health), relevant clinical guidelines are sourced directly from the Carelon MBM provider site, ensuring the correct criteria are applied to each submission.

Addressing Regulatory Compliance and Turnaround Times

For Anthem's Medicare Advantage, Medicaid, and Qualified Health Plan (QHP) lines, compliance with CMS-0057-F mandates specific 72-hour standard and 24-hour expedited decision timeframes. Klivira's platform helps practices track these critical deadlines, integrating with Practice EHR to provide real-time status updates and facilitate timely appeals, which is crucial for patient care and revenue integrity.

Optimizing Specialty Service and Pharmacy PA Workflows

Managing prior authorizations for specialty drugs, whether under the medical or pharmacy benefit, presents unique challenges. Klivira automates the submission process through appropriate channels, including CarelonRx's ePA partners for pharmacy benefits and direct routing for medical benefit specialty injectables subject to Anthem's site-of-care and clinical-indication policies.

Frequently asked questions

How does Klivira connect with Practice EHR for prior authorizations?

Klivira integrates with Practice EHR using its robust APIs to extract necessary patient demographics, clinical documentation, and order details, initiating prior authorization requests directly from your EMR for Anthem (Elevance Health) members.

Which Anthem (Elevance Health) prior authorization channels does Klivira support?

Klivira supports submissions through Availity Essentials, X12 278 transactions, Carelon Medical Benefits Management, and ePA partners like CoverMyMeds and Surescripts for pharmacy benefits, covering the diverse channels used by Anthem.

Does Klivira help with prior authorizations for advanced imaging with Anthem?

Yes, Klivira routes advanced imaging and other specialty benefit requests to Carelon Medical Benefits Management's portal, ensuring compliance with their specific submission pathways and clinical guidelines for these domains.

How does Klivira help small practices manage Anthem's varied medical policies?

Klivira centralizes access to Anthem's state-specific medical policies and Carelon Medical Benefits Management clinical guidelines, helping your team apply the correct criteria for each submission and reducing the administrative burden of policy research.

Is Klivira compliant with CMS-0057-F for Anthem Medicare Advantage plans?

Klivira's platform is designed to help practices meet the decision timeframe requirements of CMS-0057-F for Anthem's impacted lines of business by facilitating timely submissions, tracking status updates, and supporting expedited requests.