Klivira
Request demo

Streamlining Prior Authorizations with SimplePractice Change Healthcare Clearinghouse

Klivira enhances the prior authorization workflow when utilizing SimplePractice change healthcare clearinghouse for behavioral health services, reducing manual overhead and accelerating approvals.

For revenue cycle directors and prior authorization coordinators in behavioral health, managing the interplay between your EMR and clearinghouse is critical for financial health. While SimplePractice excels in practice management, integrating prior authorization processes with a clearinghouse like Change Healthcare often presents manual bottlenecks, impacting claim submission and reimbursement velocity.

Navigating Claims and Eligibility within SimplePractice

SimplePractice provides robust capabilities for managing client demographics, appointments, and billing, primarily for solo and small group behavioral health practices. Users typically initiate claims submission directly from the client's billing profile or appointment ledger within the platform, where service codes and diagnostic information are entered. This data is then prepared for electronic transmission.

The Role of Change Healthcare Clearinghouse in Behavioral Health Billing

As a national clearinghouse, Change Healthcare (now Optum Change Healthcare) acts as the crucial intermediary, receiving claim files (HIPAA X12 837) from EMRs like SimplePractice and routing them to the appropriate payers. It also facilitates eligibility verification (X12 270/271) and electronic remittance advice (X12 835), streamlining the financial cycle for behavioral health providers.

Prior Authorization Gaps in the SimplePractice to Change Healthcare Workflow

While SimplePractice efficiently manages clinical and billing data, and Change Healthcare handles claim transmission, the prior authorization process often remains a manual, disconnected step. Behavioral health practices must frequently navigate payer portals or phone calls to secure authorizations, even for services already documented in SimplePractice and destined for submission via Change Healthcare.

Key Data Points for Prior Authorization Automation

  • Client demographics (from SimplePractice client profile)
  • Diagnosis codes (ICD-10, from SimplePractice treatment plans/notes)
  • Procedure codes (CPT/HCPCS, from SimplePractice service codes)
  • Provider NPI and facility information (from SimplePractice practice settings)
  • Payer-specific authorization requirements (identified by Klivira)
  • Authorization status and tracking (managed by Klivira)

Klivira's Augmentation of SimplePractice Change Healthcare Prior Authorization

Klivira integrates with SimplePractice via its APIs to extract necessary clinical and demographic data, specifically for prior authorization requests. This data is then leveraged to automate the submission of X12 278 transactions or ePA requests to payers, often via Change Healthcare's connectivity or direct payer portal automation, ensuring that authorizations are secured proactively and accurately before claims are submitted.

Leveraging SimplePractice APIs for Prior Authorization Data Exchange

Klivira's integration strategy involves programmatically accessing relevant client and service data from SimplePractice's APIs. This allows for automated extraction of information typically found in client charts, billing entries, and progress notes, which is then mapped to the specific data elements required for X12 278 prior authorization requests, reducing the need for manual data entry into separate systems.

Frequently asked questions

How does Klivira access client data from SimplePractice for prior authorizations?

Klivira utilizes SimplePractice's secure APIs to programmatically extract necessary client demographics, diagnosis codes, and procedure codes. This ensures that the data used for prior authorization requests is accurate and directly sourced from the EMR, minimizing manual input errors.

Can Klivira help with eligibility verification through Change Healthcare?

While SimplePractice typically handles basic eligibility verification (X12 270/271) via Change Healthcare, Klivira focuses on the prior authorization (X12 278) workflow. Our platform leverages the confirmed eligibility data to ensure that authorization requests are submitted to the correct payer and plan, streamlining the overall process.

What specific prior authorization forms or types does Klivira automate for SimplePractice users?

Klivira automates the submission of prior authorization requests across various service types relevant to behavioral health, including initial evaluations, ongoing therapy sessions, and specific treatment modalities. This includes generating and submitting X12 278 transactions or navigating payer-specific ePA portals, based on the payer's requirements.

How does Klivira handle prior authorization denials when using SimplePractice and Change Healthcare?

Klivira's platform tracks the status of all submitted prior authorization requests. In the event of a denial, our system flags it for review and provides actionable insights, often including the specific denial reason. This allows prior authorization coordinators to efficiently address the denial, whether through appeals or resubmission, directly within our workflow.

Is the data exchanged between SimplePractice, Klivira, and Change Healthcare HIPAA compliant?

Yes, all data exchanges between SimplePractice, Klivira, and Change Healthcare are conducted with stringent adherence to HIPAA regulations. Klivira maintains robust security protocols, including encryption and access controls, to protect ePHI throughout the prior authorization automation process.

Related coverage

Other simple-practice prior auth coverage

Ready to automate prior auth for this integration?

See how Klivira automates prior authorizations for your team.

Request a demo