Sevocity Anthem (Elevance Health) Prior Authorization Automation

Klivira delivers Sevocity Anthem (Elevance Health) prior authorization automation, directly connecting specialty ambulatory practices to critical payer channels for efficient approvals.

For specialty ambulatory practices utilizing Sevocity, navigating Anthem (Elevance Health) prior authorization requirements presents unique operational challenges. The fragmented submission landscape across medical, pharmacy, and specialty benefit managers often leads to delays and increased administrative burden. Klivira provides a unified solution to streamline these complex workflows.

Bridging Sevocity to Anthem's Diverse PA Channels

Klivira integrates directly with Sevocity APIs, enabling automated submission to Anthem (Elevance Health) across its varied prior authorization channels. This includes medical benefit PAs routed through Availity Essentials, pharmacy PAs via CarelonRx and ePA partners like CoverMyMeds and Surescripts, and specialty benefit management requests directed to Carelon Medical Benefits Management.

Navigating Anthem (Elevance Health) Prior Authorization Gateways

Availity Essentials for medical PAs, inpatient admission notifications, and concurrent review intake.
Carelon Medical Benefits Management portal for advanced imaging, cardiology, MSK, sleep, and radiation oncology.
CarelonRx for pharmacy benefit medications, including retail PA workflows.
X12 278 transactions for eligible services, supported via clearinghouses.
Direct ePA through CoverMyMeds and Surescripts for prescriber-initiated pharmacy workflows.

Specialty Practice Workflow Optimization with Sevocity APIs

Sevocity's customizable cloud EHR, with its strong specialty templates, is a core system for ambulatory practices. Klivira leverages Sevocity APIs to embed prior authorization workflows directly within the EMR, reducing context switching and manual data entry for PA coordinators. This integration ensures that patient and clinical data flow seamlessly from Sevocity to Anthem's required submission formats.

Addressing Common Anthem Prior Authorization Challenges

Anthem (Elevance Health) prior authorization denials frequently stem from medical necessity, site-of-service mismatches, or insufficient documentation. Klivira's platform helps mitigate these by providing real-time policy insights from Anthem's medical-policy libraries (accessed via Availity) and Carelon Medical Benefits Management's clinical guidelines, facilitating accurate submissions. For Medicare Advantage and Medicaid lines, Klivira also supports considerations for CMS-0057-F turnaround timeframes.

Enhancing Efficiency for High-Volume Specialty Services

For specialty ambulatory practices managing high-volume services such as advanced imaging, biologics, or certain GLP-1 medications, the prior authorization burden is substantial. Klivira automates the submission and tracking of these critical requests, whether they route through Carelon Medical Benefits Management for imaging or direct Anthem medical benefit channels for specialty drugs, improving overall operational efficiency.

Frequently asked questions

How does Klivira integrate with Sevocity for Anthem PAs?

Klivira integrates with Sevocity via its robust APIs, allowing for the direct extraction of patient demographics, clinical notes, and order details. This data is then formatted and transmitted to the appropriate Anthem (Elevance Health) prior authorization channel, streamlining the submission process without requiring manual data re-entry.

Which Anthem (Elevance Health) PA channels does Klivira support?

Klivira supports all major Anthem (Elevance Health) prior authorization channels, including Availity for medical benefit PAs, Carelon Medical Benefits Management for specialty services like advanced imaging, and ePA partners like CoverMyMeds and Surescripts for pharmacy benefits. We also facilitate X12 278 transactions for eligible services.

How does Klivira help with Carelon Medical Benefits Management submissions?

Klivira automates the submission process for services managed by Carelon Medical Benefits Management (formerly AIM Specialty Health), such as advanced imaging and musculoskeletal procedures. Our platform ensures that all necessary clinical documentation from Sevocity is accurately routed to the Carelon MBM portal, aligning with their specific submission requirements.

Can Klivira help manage Anthem's site-of-service policies?

Yes, Klivira helps address Anthem's site-of-service policies by providing clear guidance and supporting documentation requirements during the prior authorization process. By integrating with payer policy data, the platform helps identify potential site-of-service mismatches before submission, reducing the likelihood of denials.

Does Klivira assist with appeals for Anthem (Elevance Health) denials?

Klivira streamlines the appeal process by centralizing denial reasons and facilitating the submission of additional documentation. For denials from standard medical PAs, we support the Anthem operating company appeal pathway. For Carelon Medical Benefits Management denials, we guide users through their distinct appeal process.