Streamlining Dermatology Prior Authorization with Epic Orchestrate

Klivira transforms the **dermatology Epic Orchestrate** workflow, embedding intelligent prior authorization automation directly into your clinical and administrative processes for biologics, specialty drugs, and Mohs surgery.

Revenue cycle leaders and prior authorization teams in dermatology face unique challenges, from managing complex biologic step-therapy requirements to navigating payer policies for Mohs micrographic surgery. Integrating PA automation into Epic's native workflow, specifically through Epic Orchestrate, is crucial for improving efficiency and reducing administrative burden. This approach ensures that critical PA data flows seamlessly, minimizing manual tasks and accelerating time to treatment.

The Intersection of Dermatology PA and Epic Orchestrate

Dermatology prior authorization frequently involves high-cost biologics for conditions like psoriasis and atopic dermatitis, alongside complex surgical procedures such as Mohs surgery. Epic Orchestrate provides a powerful framework for integrating external applications and automating workflows directly within the Epic environment, enabling Klivira to embed PA intelligence precisely where it's needed during the patient journey. This integration ensures that PA requirements are addressed proactively, leveraging existing Epic data.

Key Dermatology PA Triggers Automated via Epic Orchestrate

Biologics for psoriasis (e.g., Dupixent, Cosentyx, Tremfya, Skyrizi) and atopic dermatitis
Specialty topicals and advanced skin cancer treatments
Mohs micrographic surgery, especially for cosmetically sensitive areas
Periodic re-authorizations for chronic biologic therapies
Phototherapy, distinguishing between clinic and home administration

Optimizing Documentation and Clinical Guideline Adherence

Effective dermatology PA relies heavily on precise documentation and adherence to clinical guidelines. Within Epic Orchestrate, Klivira guides users to capture necessary data points, such as PASI/BSA scores for psoriasis or EASI/SCORAD for atopic dermatitis, directly from the patient's chart. This integration supports compliance with AAD Clinical Guidelines and NCCN guidelines for skin cancers, ensuring that required trials of prior therapies (e.g., topicals, phototherapy, conventional systemics) and pre-biologic screenings (TB, hepatitis) are documented accurately before submission.

Addressing Common Dermatology PA Denial Reasons

Inadequate documentation of step therapy completion for biologics
Discrepancies with Mohs Appropriate Use Criteria (AUC) for site or tumor type
Missing or insufficient disease severity scores (PASI, EASI, BSA)
Gaps in pre-biologic screening documentation (TB, hepatitis)
Payer-mandated biosimilar substitution not addressed

Klivira's Intelligent Automation within Epic Orchestrate

Klivira deploys SMART on FHIR applications within Epic Orchestrate, providing a seamless, Epic-native experience for prior authorization. Our platform leverages the Da Vinci PAS standards to automate the submission of X12 278 transactions and integrate with payer portals and PBMs. For dermatology, this means real-time validation against payer policies, smart routing for medical-vs-pharmacy benefits for self-injection vs. clinic infusion, and proactive management of periodic re-authorization cycles, all orchestrated within your existing Epic workflows.

Enhanced Efficiency for Dermatology Workflows

By integrating deep into Epic Orchestrate, Klivira helps dermatology practices streamline the prior authorization process from order entry to approval. This reduces the manual burden on PA coordinators, minimizes delays in patient care for critical treatments, and decreases the likelihood of denials due to administrative errors or incomplete documentation. The result is improved revenue cycle performance and enhanced patient satisfaction, allowing clinical staff to focus more on patient care.

Frequently asked questions

How does Klivira handle the distinction between medical and pharmacy benefits for dermatology biologics within Epic Orchestrate?

Klivira automatically identifies whether a dermatology biologic will be administered via self-injection (pharmacy benefit) or clinic infusion (medical benefit). Within Epic Orchestrate, our system routes the PA request through the appropriate channel, whether it's an NCPDP SCRIPT for pharmacy or an X12 278 for medical, ensuring accurate submission and reducing delays.

Can Klivira help with periodic re-authorizations for chronic dermatology conditions like psoriasis?

Yes, Klivira is designed to manage the lifecycle of prior authorizations, including periodic re-authorizations common for chronic dermatology conditions requiring biologics. Our system tracks approval expiry dates and proactively initiates the re-authorization process within Epic Orchestrate, prompting for updated documentation and submitting renewal requests to payers, preventing treatment interruptions.

How does Klivira ensure compliance with Mohs surgery Appropriate Use Criteria (AUC) when integrated with Epic Orchestrate?

For Mohs surgery, Klivira integrates logic based on AAD Appropriate Use Criteria directly into the Epic Orchestrate workflow. When a Mohs procedure is ordered, the system prompts for necessary documentation regarding the site, tumor type, and any prior treatments, validating these against payer policies and AUC to ensure the PA request is robust and aligned with guidelines.

What specific Epic modules does Klivira interact with when implementing dermatology Epic Orchestrate workflows?

Klivira's integration through Epic Orchestrate primarily leverages Epic's order entry, documentation (e.g., EpicCare Ambulatory), and charge capture modules. By utilizing SMART on FHIR capabilities, Klivira embeds directly into the clinician and PA coordinator workflows within Hyperdrive and other Epic surfaces, accessing and updating patient data seamlessly.

How does Klivira help reduce denial rates for dermatology biologics due to step therapy issues?

Klivira incorporates AAD-guideline-aware step-therapy logic directly into the Epic Orchestrate workflow. Our system checks for documented trials of prior topical, phototherapy, or conventional systemic therapies. If documentation is missing or incomplete, the system flags it, guiding the user to provide the necessary information before PA submission, thereby significantly reducing denials related to step therapy non-compliance.