Optimize Devoted Health Prior Authorization Automation with Klivira

The Challenge of Devoted Health Prior Authorizations in Manual Workflows

Managing prior authorizations for Medicare Advantage plans, including Devoted Health, often involves a labor-intensive manual workflow. This process typically requires staff to manually check PA requirements, assemble documentation from the EMR, submit requests via various payer-specific channels, and continuously track decision status. These steps are prone to errors, delays, and missed deadlines, consuming valuable administrative and clinical staff time.

Klivira's Automated Approach to Devoted Health Prior Authorizations

Klivira's platform automates the entire prior authorization lifecycle for payers like Devoted Health. From intelligent detection of PA requirements at the point of order entry in the EMR to automated documentation assembly and submission, we eliminate manual touchpoints. This ensures that requests are submitted accurately and efficiently, leveraging appropriate electronic channels such as Da Vinci PAS, X12 278, or payer portals, with fax as a fallback.

Key Automation Capabilities for Devoted Health PAs

• **EMR-Integrated Detection:** Utilizing CDS Hooks and SMART on FHIR, Klivira identifies PA requirements for Devoted Health services at the moment an order is placed in your EMR.
• **Automated Documentation Assembly:** Klivira pulls necessary clinical notes, lab results, and imaging reports from FHIR resources in your EMR, compiling comprehensive documentation packets per Devoted Health's criteria.
• **Intelligent Submission Routing:** Requests are routed through the most efficient electronic channel available for Devoted Health, prioritizing Da Vinci PAS API and X12 278, optimizing for speed and compliance.
• **Real-Time Status Tracking:** Klivira monitors the status of Devoted Health PA requests, providing real-time updates to PA coordinators and ordering clinicians directly within the EMR.
• **Automated Approval Write-back:** Upon approval, authorization numbers are automatically written back to the EMR's order record, ensuring accurate claim submission and reducing manual data entry.

Adhering to Medicare Advantage Regulations: CMS-0057-F

For Medicare Advantage plans like Devoted Health, compliance with federal regulations such as CMS-0057-F is critical. Klivira's platform is designed to support the interoperability and prior authorization final rule, including the mandated 72-hour standard and 24-hour expedited PA decision timeframes. Our automation helps organizations meet these regulatory requirements by accelerating submission and tracking processes.

Addressing Operational Failure Modes for Devoted Health PAs

Klivira's automation directly addresses common failure modes encountered in manual Devoted Health prior authorization workflows. This includes eliminating missed PA-required orders at detection, minimizing documentation gaps that trigger callbacks, preventing lost-to-follow-up appeals, and ensuring timely-filing window compliance. The platform also resolves status-unknown cases by providing real-time visibility into payer decisions.

Beyond Approvals: Denial Management and Appeals for Devoted Health

When a Devoted Health prior authorization request results in a denial, Klivira automates the subsequent steps. The system parses denial reasons, routes cases for auto-appeal or human review based on clinical judgment needs, and facilitates peer-to-peer scheduling. Klivira's appeal workflow auto-assembles necessary packets and tracks appeal status, ensuring that all avenues for approval are pursued efficiently and within timely-filing limits.