Streamlining Valant Anthem (Elevance Health) Prior Authorization Automation

Klivira provides comprehensive Valant Anthem (Elevance Health) prior authorization automation, specifically designed to navigate the complexities of behavioral health and substance use treatment approvals.

For clinics and health systems utilizing Valant as their specialty EHR, managing prior authorizations for Anthem (Elevance Health) members presents a unique challenge. The diverse submission channels and specific policy requirements, particularly for behavioral health services, often lead to manual workflows, delays, and administrative overhead. Klivira addresses these pain points by integrating directly with Valant and intelligently routing submissions to Anthem's various PA pathways.

The Specifics of Valant-Anthem Prior Authorization Workflows

Valant's focus on behavioral health and substance use treatment means that prior authorization requests often involve nuanced clinical criteria and specific payer pathways. Anthem, as an Elevance Health company, utilizes multiple channels for PA submissions, including Availity for medical benefits, Carelon Behavioral Health for many behavioral health services, and CarelonRx for pharmacy benefits, creating a complex landscape for providers to navigate efficiently.

Klivira's Deep Integration with Valant EMR

Klivira connects directly with Valant through its robust Valant APIs. This integration allows prior authorization requests to be initiated and managed from within the EMR environment, leveraging existing patient data. By automating data extraction and submission, Klivira reduces manual data entry, minimizes errors, and ensures that behavioral health providers can focus more on patient care and less on administrative tasks.

Navigating Anthem's Diverse Prior Authorization Channels

Anthem-licensed plans, under Elevance Health, employ a multi-channel approach to prior authorization. Klivira's platform intelligently routes your Valant-originated PA requests to the appropriate Anthem channel, whether it's the Availity Essentials multi-payer portal for medical PAs, X12 278 transactions via clearinghouses, or specific portals like Carelon Behavioral Health for behavioral health services, and CoverMyMeds or Surescripts ePA for pharmacy benefits via CarelonRx.

Key Prior Authorization Pathways for Valant Users with Anthem

**Medical Benefit PAs:** Routed through Availity Essentials, supporting X12 278 for impacted procedures.
**Behavioral Health PAs:** Often managed through Carelon Behavioral Health, requiring specific submission protocols.
**Pharmacy Benefit PAs:** Processed via CarelonRx's provider PA system or through CoverMyMeds / Surescripts ePA.
**Specialty Services PAs:** Advanced imaging, cardiology, MSK, sleep, and radiation oncology route through Carelon Medical Benefits Management's dedicated portal.
**Utilization Management Policy Access:** Klivira helps access Anthem medical policies and clinical UM guidelines via Availity, or Carelon MBM clinical guidelines directly from their provider site for relevant procedures.

Accelerating Prior Authorization Decisions and Compliance

Klivira's automation helps Valant users meet critical turnaround times for Anthem PAs. For Medicare Advantage, Medicaid managed-care (under Anthem Medicaid plans and Wellpoint), and QHP-on-FFM lines, Klivira supports compliance with CMS-0057-F regulations, ensuring adherence to 72-hour standard and 24-hour expedited decision timeframes. Our system helps ensure submissions are complete and accurate, reducing rejections and appeals.

Evidence-Based Policy Adherence for Behavioral Health Services

Anthem operating companies publish extensive medical policy and clinical UM guideline libraries, often accessible through provider sites via Availity. For behavioral health services, specific guidelines from Carelon Behavioral Health are crucial. Klivira's automation facilitates the inclusion of necessary clinical documentation, helping ensure submissions align with Anthem-developed, Carelon-developed, or other criteria (e.g., MCG-based) as cited in the relevant policy.

Frequently asked questions

How does Klivira integrate with Valant for prior authorizations?

Klivira integrates directly with Valant using Valant APIs. This allows for seamless extraction of patient and clinical data from the EMR, enabling automated initiation and management of prior authorization requests without manual data transfer.

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

Klivira supports a wide range of Anthem channels, including Availity Essentials for medical PAs, X12 278 transactions, Carelon Behavioral Health for behavioral health services, CarelonRx for pharmacy PAs (via CoverMyMeds/Surescripts ePA), and Carelon Medical Benefits Management for specialty services like advanced imaging.

Does Klivira specifically help with behavioral health prior authorizations for Anthem?

Yes, given Valant's specialization, Klivira is particularly effective for behavioral health PAs with Anthem. We understand the specific routing often required through Carelon Behavioral Health and ensure that submissions align with their clinical guidelines and documentation requirements.

How does Klivira help ensure compliance with Anthem's medical policies?

Klivira helps ensure compliance by facilitating access to Anthem's medical policies and clinical guidelines, whether through Availity or Carelon's dedicated portals. Our automation helps ensure that submitted documentation directly addresses the criteria outlined in these policies, reducing the likelihood of denials due to insufficient information.

Can Klivira assist Valant users in meeting CMS-0057-F requirements for Anthem plans?

Absolutely. For Anthem's Medicare Advantage, Medicaid managed-care, and QHP-on-FFM lines, Klivira's automation helps accelerate the prior authorization process, enabling providers to meet the 72-hour standard and 24-hour expedited decision timeframes mandated by CMS-0057-F.