Aetna Olive AI Replacement: Streamlining Prior Authorization Migration

Addressing the Aetna Olive AI Replacement Challenge

The discontinuation of Olive AI necessitates a strategic migration for prior authorization operations. For Aetna-specific workflows, this means re-establishing efficient connectivity to payer systems and integrating with internal EMRs to prevent backlogs and maintain claim integrity. Klivira’s platform is engineered to facilitate this transition, offering a stable and scalable automation solution.

Aetna's Prior Authorization Submission Channels for Automation

Aetna utilizes distinct submission channels for medical and pharmacy benefits. Understanding these pathways is crucial for any automation platform. Klivira's architecture is designed to interface with Aetna's established mechanisms, ensuring compliant and efficient prior authorization submissions.

Key Aetna PA Submission Pathways

• **Medical Benefit PA:** Aetna routes most medical-benefit precertification requests through the Availity provider portal. Klivira integrates directly with such portals and supports X12 278 transactions for applicable procedure categories via clearinghouses.
• **Pharmacy Benefit PA:** Administered through CVS Caremark, pharmacy-benefit PA submissions route through ePA partners like CoverMyMeds or Surescripts for retail, and CVS Caremark's direct provider portal for mail-order scenarios.
• **Specialty Drug PA (Medical Benefit):** Some specialty injectables and infusions are managed under the medical benefit, requiring specific workflows often supported by benefit-management tooling.
• **Inpatient Admission Notification:** Concurrent review intake processes are documented on Aetna's precertification page, with notification windows varying by line of business and state regulations.

Navigating Aetna's Clinical Policy Bulletins (CPBs)

Aetna's medical-necessity criteria are published as Clinical Policy Bulletins (CPBs) in their public library. These CPBs are versioned, dated, and serve as the canonical source for coverage requirements. Klivira’s platform can integrate with such policy libraries, aiding in the automated identification and application of relevant criteria for Aetna prior authorizations.

Turnaround Times and Compliance Considerations for Aetna

Aetna's PA turnaround times are governed by state insurance regulations for commercial plans, NCQA Utilization Management accreditation standards, and payer-published service-level targets. For Medicare Advantage, Medicaid managed-care, and QHP-on-FFM lines, Aetna is an impacted payer under CMS-0057-F, requiring 72-hour decisions for standard and 24-hour for expedited PA requests on a phased timeline. Klivira helps track and manage submissions against these varied compliance windows.

Klivira's Approach to Aetna Prior Authorization Automation

As an Aetna Olive AI replacement, Klivira offers an intelligent automation platform designed for high-volume prior authorization workflows. Our solution integrates with your existing EMR via SMART on FHIR, automates data extraction and submission to Aetna's Availity portal and X12 278 channels, and streamlines documentation gathering. This ensures continuity and enhances efficiency as you transition your PA operations.