Mastering Gastroenterology Fax & Paper Form Automation

For gastroenterology practices facing a high volume of prior authorizations, Klivira delivers robust gastroenterology fax & paper form automation, transforming manual processes into efficient digital workflows.

Gastroenterology prior authorizations are complex, frequently involving high-cost biologics, advanced imaging, and specialized procedures. While many payers transition to digital channels like X12 278 or payer portals, a significant portion still relies on traditional fax and paper forms, creating a substantial administrative burden. Klivira's platform is engineered to tackle these long-tail payer fax workflows, ensuring no authorization is delayed due to outdated submission methods.

The Persistent Challenge of Fax & Paper in GI Prior Authorizations

Gastroenterology practices navigate a landscape where critical treatments like IBD biologics (e.g., Humira, Stelara, Skyrizi, Entyvio), advanced imaging (MRCP, CT enterography), and endoscopic procedures (capsule endoscopy, ERCP) frequently require prior authorization. Despite advancements in ePA, many regional payers and specific plans continue to demand submissions via fax or proprietary PDF forms. This leads to manual data entry, printing, faxing, and tracking, consuming valuable staff time and delaying patient access to essential GI care.

Common Gastroenterology Procedures and Medications Requiring Fax & Paper PA

IBD Biologics: Initial and re-authorization for TNF inhibitors (adalimumab, infliximab), integrin inhibitors (vedolizumab), IL-12/23 inhibitors (ustekinumab), and JAK inhibitors (tofacitinib).
Hepatitis C DAAs: Sofosbuvir-velpatasvir (Epclusa) and glecaprevir-pibrentasvir (Mavyret), especially for treatment-naive vs. experienced pathways.
Advanced Imaging: MRCP, MR enterography, and CT enterography for IBD assessment or other complex abdominal conditions.
Specialized Endoscopic Procedures: Capsule endoscopy (CPT 91110), small-bowel enteroscopy, and ERCP for specific diagnostic or therapeutic indications.
Select Specialty Drugs: Medications for functional GI disorders like eluxadoline (Viberzi) or prucalopride (Motegri).
Bariatric Surgery: Gastric bypass or sleeve gastrectomy, where payer-specific forms are common.

Automating Documentation for GI-Specific Payer Policies

Klivira's platform employs intelligent OCR and form-filling technology to automate the extraction of necessary clinical data from EMRs and populate payer-specific fax forms. This includes critical details like diagnosis confirmation, disease severity assessments (e.g., Mayo score for UC, CDAI for Crohn's), prior conventional and biologic therapy trials, and essential screenings (TB, hepatitis). Our system is designed to align with ACG, AGA, and AASLD guidelines, ensuring documentation completeness and reducing denials related to step therapy or missing clinical criteria.

Streamlining EMR and Payer Touchpoints for GI Fax Workflows

EMR Integration: Bi-directional data exchange with leading EMRs via SMART on FHIR, pulling patient demographics, medication history, lab results, and clinical notes.
Order Type Automation: Triggering PA workflows directly from medication orders for biologics or procedure orders for advanced imaging and endoscopies.
Payer Form Library: Maintaining an up-to-date library of thousands of payer-specific fax forms and PDFs, automatically selecting the correct version.
Automated Submission: Digitally preparing and submitting fax forms, eliminating manual printing and physical fax machine use.
Status Tracking: Centralized dashboard for real-time tracking of all faxed PA submissions, including confirmation of receipt.
Denial Management: Flagging common GI-specific denial reasons such as biosimilar substitution mandates or insufficient disease severity documentation.

Addressing the Chronic Burden of GI Prior Authorizations

Gastroenterology involves a significant volume of chronic care, particularly for IBD biologics, which often require periodic re-authorization every 6 or 12 months. Klivira's automation platform proactively manages these recurring PA cycles, pre-populating forms with updated clinical data and submitting them ahead of expiration. This capability, combined with intelligent routing for medical vs. pharmacy benefit agents and accurate treatment-naive vs. treatment-experienced classification, minimizes administrative overhead and ensures uninterrupted patient access to vital, ongoing GI therapies.

Frequently asked questions

How does Klivira handle the variability in biosimilar substitution policies for GI biologics?

Klivira's platform incorporates payer-specific policy logic that accounts for varying biosimilar mandates. For GI biologics like TNF inhibitors, our system identifies whether a biosimilar is required or preferred by a specific payer and helps ensure the correct documentation or agent is submitted, mitigating denials related to biosimilar substitution.

Can Klivira automate prior authorizations for both medical and pharmacy benefit GI drugs?

Yes, Klivira supports both medical and pharmacy benefit prior authorizations. For GI biologics that can be provider-administered (medical benefit) or self-injected (pharmacy benefit), our platform intelligently routes the PA request to the appropriate channel (e.g., X12 278 for medical, NCPDP SCRIPT for pharmacy, or automated fax for either when digital channels are unavailable), ensuring accurate submission regardless of benefit type.

How does Klivira ensure the correct clinical documentation is included for GI procedures like capsule endoscopy or ERCP?

Klivira's automation leverages EMR integration to pull relevant clinical data such as prior workup (e.g., upper GI series, EGD), specific indications (obscure GI bleeding, IBD evaluation), and conservative evaluation completion. This data is then used to accurately populate payer-specific fax forms, aligning with medical necessity criteria and reducing denials for procedures like capsule endoscopy.

What if a payer requires a very specific, non-standard form for a GI procedure?

Klivira maintains an extensive and continuously updated library of payer-specific forms, including those for long-tail payers and niche GI procedures. Our system identifies the exact form required based on the payer, plan, and service, then uses intelligent automation to populate it with relevant patient and clinical data extracted from your EMR, ensuring compliance with unique payer requirements.

How does Klivira manage recurring prior authorizations for chronic GI conditions like IBD?

For chronic GI conditions requiring ongoing biologic therapy, such as Crohn's disease or ulcerative colitis, Klivira's platform includes a robust re-authorization workflow. It tracks authorization expiration dates, proactively initiates new PA requests, and automatically populates forms with updated disease activity scores and treatment response documentation, minimizing gaps in care.