Streamlining Anthem (Elevance Health) Prior Authorizations Post-Olive AI Replacement

Clinics and health systems seeking an Anthem (Elevance Health) Olive AI replacement solution can leverage Klivira's automation platform to maintain prior authorization efficiency and accuracy.

The discontinuation of Olive AI's prior authorization services necessitates a strategic transition for organizations managing Anthem (Elevance Health) payer workflows. Revenue cycle directors and prior authorization coordinators require a robust, integrated solution that can navigate Anthem's diverse submission channels and policy structures. Klivira provides a clear pathway to mitigate disruption and enhance operational continuity.

Navigating Anthem's Diverse Prior Authorization Channels

Anthem, operating under Elevance Health, utilizes multiple channels for prior authorization submissions. Klivira's platform is engineered to integrate with these specific entry points, ensuring comprehensive coverage for medical and pharmacy benefits. This includes direct connectivity for X12 278 transactions and intelligent routing through designated portals.

Klivira's Integration Approach for Anthem (Elevance Health) Workflows

**Medical Benefit PAs**: Automation of submissions and status checks via Availity Essentials, Anthem's primary multi-payer provider workspace.
**Specialty Benefit Management**: Direct integration with Carelon Medical Benefits Management (formerly AIM Specialty Health) for advanced imaging, cardiology, MSK, sleep, and radiation oncology.
**Pharmacy Benefit PAs**: Support for retail pharmacy prior authorizations through CarelonRx's provider system and ePA partners like CoverMyMeds and Surescripts (NCPDP SCRIPT).
**Electronic Data Interchange (EDI)**: Full support for X12 278 transactions via clearinghouses for medical benefit prior authorizations.
**Policy Lookups**: Streamlined access to Anthem's medical policy and clinical UM guideline libraries, along with Carelon MBM's specific clinical guidelines.

Compliance and Turnaround Time Management

Anthem-licensed plans operate under varying state-specific regulations for commercial prior authorization turnaround times. For Medicare Advantage, Medicaid managed-care (under Anthem Medicaid plans and Wellpoint), CHIP, and QHP-on-FFM lines, compliance with CMS-0057-F mandates specific decision timeframes (72-hour standard, 24-hour expedited). Klivira's system provides visibility and tracking to help meet these critical deadlines and support compliance efforts.

Leveraging Electronic Prior Authorization (ePA) Capabilities

Elevance Health has engaged in Da Vinci Project initiatives, indicating a strategic direction towards FHIR-based electronic prior authorization (ePA). Klivira's platform aligns with these advancements, supporting the transition to more efficient, data-driven PA processes. This includes leveraging existing ePA channels like CoverMyMeds and Surescripts for pharmacy benefits and integrating with Carelon MBM's dedicated electronic submission pathway.

Addressing Common Anthem Denial Patterns

Anthem denials often stem from medical necessity, insufficient documentation, step therapy non-compliance, or site-of-service mismatches due to active Carelon policies. Klivira's intelligent automation helps identify and mitigate these common issues pre-submission, improving first-pass approval rates. In the event of a denial, the platform supports the appropriate appeal pathways, whether through the standard Anthem operating-company process or Carelon MBM's distinct appeals system.

Frequently asked questions

How does Klivira handle the transition from Olive AI for Anthem prior authorizations?

Klivira provides a structured migration path, integrating directly with Anthem's established prior authorization channels, including Availity, Carelon Medical Benefits Management, and X12 278. Our platform automates submission, status checks, and documentation, ensuring minimal disruption to your revenue cycle operations.

Which specific Anthem (Elevance Health) portals does Klivira integrate with?

Klivira integrates with key Anthem (Elevance Health) portals and systems, including Availity Essentials for medical benefit PAs and Carelon Medical Benefits Management's provider portal for specialty benefit categories like advanced imaging and cardiology. We also support ePA through CoverMyMeds and Surescripts for pharmacy benefits.

Can Klivira help our organization comply with CMS-0057-F for Anthem Medicare Advantage plans?

Yes, Klivira's platform is designed to support compliance with CMS-0057-F for impacted payers, including Anthem's Medicare Advantage and Medicaid managed-care plans. We provide tools to track and manage prior authorization requests within the mandated 72-hour standard and 24-hour expedited decision timeframes, aiding your compliance efforts.

How does Klivira access Anthem's medical policies and clinical criteria?

Klivira facilitates access to Anthem's medical policy and clinical UM guideline libraries typically found via provider sites accessed through Availity. For procedures routed through Carelon Medical Benefits Management, we direct users to the specific clinical guidelines published on the Carelon MBM provider site, ensuring you reference the correct criteria for each submission.

What is Klivira's strategy for addressing common Anthem denial reasons?

Klivira's automation helps proactively address common Anthem denial reasons such as medical necessity, insufficient documentation, step therapy requirements, and site-of-service mismatches. By ensuring complete and accurate submissions aligned with payer policies, we aim to reduce denials and streamline the appeals process when necessary.