Streamlining Wellpoint SMART on FHIR Prior Auth with Klivira

The Challenge of Traditional Wellpoint Prior Auth Workflows

Without an integrated solution, prior authorization for Wellpoint's government programs typically forces clinicians and coordinators to leave the EMR. This context-switching and manual data transfer introduce significant inefficiencies, leading to delays and potential errors in securing approvals for essential services.

Common Friction Points in Manual PA Submissions to Payers like Wellpoint

• High context-switching costs for staff moving between EMR and external PA systems.
• Manual context-transfer errors during retyping of patient and encounter data.
• Gaps and inconsistencies when pulling clinical documentation from disparate sources.
• Inconsistent or unstructured write-back of PA outcomes into the patient's EHR.

Klivira's SMART on FHIR Solution for Wellpoint Prior Auth

Klivira leverages SMART on FHIR to embed the prior authorization workflow directly within the EMR. This allows providers to initiate and manage Wellpoint prior auth requests without leaving their clinical system, ensuring patient and encounter context is automatically transferred via FHIR R4.

Key Benefits of In-EMR Prior Auth for Wellpoint Plans

By integrating the prior authorization process into the EMR, Klivira significantly reduces administrative burden and improves data accuracy for Wellpoint-covered services. This streamlined approach accelerates approval times and enhances the overall patient experience for Medicaid and Medicare Advantage members.

How Klivira Enhances Wellpoint Prior Auth with SMART on FHIR

• **EHR-Launched Workflow:** Klivira launches directly from Epic, Cerner, athenahealth, or MEDITECH via SMART App Launch.
• **Single Sign-On:** Clinician's EHR identity authenticates via SMART OAuth 2.0, eliminating separate logins.
• **FHIR R4 Clinical Context Read:** Automatically pulls US Core resources from the EHR, eliminating manual data entry.
• **Integrated PA Workflow:** Coverage discovery (Da Vinci CRD), documentation (Da Vinci DTR), and submission (Da Vinci PAS) occur within the launched application.
• **FHIR R4 Write-Back:** PA decisions and status updates are written back to the EHR as structured DocumentReference, Communication, or Task resources.

Leveraging Da Vinci PAS and FHIR Standards for Payers like Wellpoint

Klivira's platform supports the Da Vinci PAS, CRD, and DTR Implementation Guides, enabling automated data exchange and decision support. As payers like Wellpoint expand their support for these FHIR-based standards, Klivira is positioned to integrate seamlessly, further automating the prior authorization process for government programs.

Considerations for Wellpoint Prior Auth Integration

While SMART on FHIR offers transformative potential, providers must consider factors such as EHR-side resource availability and the necessity for robust fallback channels. Klivira's integration layer is designed to manage these complexities, ensuring reliable prior authorization processing for Wellpoint members, even as payer-specific FHIR capabilities evolve.