Optimizing Neurology Prior Authorization Workflows with Epic Orchestrate

Klivira's integration with Epic Orchestrate empowers neurology practices to streamline prior authorization, embedding critical automation directly within their native Epic workflows.

For revenue cycle directors and prior authorization coordinators in neurology, managing the high volume and complex documentation for specialty drugs and advanced imaging is a significant operational challenge. Epic Orchestrate offers a powerful framework for workflow enhancement, and integrating advanced PA automation within this environment is key to reducing administrative burden and accelerating patient access to care.

The Unique Prior Authorization Demands of Neurology

Neurology prior authorization is characterized by a high volume of complex specialty medications, including MS disease-modifying therapies (DMTs), CGRP migraine biologics, and emerging Alzheimer's anti-amyloid antibodies. These often require extensive documentation, adherence to specific clinical guidelines like AAN Practice Guidelines, and frequent re-authorizations, creating significant administrative overhead.

Critical Prior Authorization Triggers in Neurology

MS DMTs (e.g., ocrelizumab, natalizumab) requiring McDonald criteria, EDSS, relapse history, and MRI findings.
Alzheimer's anti-amyloid antibodies (e.g., lecanemab, donanemab) with demands for amyloid confirmation (PET/CSF), MRI for ARIA screening, and APOE genotyping.
CGRP migraine prevention biologics (e.g., erenumab, fremanezumab) needing detailed migraine diaries and evidence of prior oral preventive failures.
Botox for chronic migraine, spasticity, or dystonia, requiring specific indication and prior therapy trials.
Advanced imaging like brain MRI, MR angiography, and amyloid PET scans.

Klivira's Automation within Epic Orchestrate for Neurology

Klivira leverages Epic Orchestrate's native workflow capabilities and SMART on FHIR app placement to embed intelligent prior authorization automation directly into the neurology care pathway. This integration means PA requests for high-cost neurology drugs and procedures are initiated, tracked, and managed without leaving the familiar Epic environment, minimizing context switching and improving data flow.

Streamlining Complex Neurology Workflows

Our platform specifically addresses common neurology PA challenges by incorporating AAN-guideline-aware step-therapy logic for MS DMTs, automating diagnostic-biomarker documentation for Alzheimer's anti-amyloid therapies, and tracking CGRP migraine prevention step-therapy requirements. This ensures that the necessary clinical evidence is systematically gathered and submitted, reducing common denial reasons like 'step therapy for MS DMTs' or 'amyloid biomarker confirmation gaps.'

Enhancing Payer and EMR Touchpoints

Klivira connects seamlessly with payer portals and utilizes X12 278 and ePA standards, streamlining the submission process directly from Epic. For neurology, this means that orders for drugs like ocrelizumab or lecanemab, or advanced imaging, trigger automated PA workflows. The system tracks periodic re-authorizations for chronic treatments and integrates MRI monitoring requirements, ensuring timely renewals and compliance.

Accelerating Patient Access to Neurology Therapies

By automating the most arduous aspects of neurology prior authorization, Klivira within Epic Orchestrate significantly reduces administrative delays. This efficiency allows neurology patients to access critical treatments for conditions like MS, Alzheimer's, and chronic migraine more quickly, improving patient satisfaction and supporting better clinical outcomes.

Frequently asked questions

How does Klivira handle the specific documentation for Alzheimer's anti-amyloid therapies within Epic Orchestrate?

Klivira automates the collection and submission of critical documentation such as amyloid confirmation (PET or CSF), MRI for ARIA screening, and APOE genotyping, as required for anti-amyloid antibodies like lecanemab. This ensures all necessary data is compiled directly from Epic and presented to payers.

Can Klivira manage re-authorizations for chronic neurology treatments like MS DMTs through Epic Orchestrate?

Yes, Klivira tracks the re-authorization schedules for chronic neurology medications. The system proactively prompts for necessary updates and re-submissions within your Epic workflow, ensuring continuity of care for patients on long-term therapies.

What role does Epic Orchestrate play in streamlining CGRP migraine biologic PAs?

Klivira integrates within Epic Orchestrate to guide users through the specific step-therapy requirements for CGRP migraine prevention biologics. It helps document prior oral preventive trial failures and track migraine days, ensuring compliance with payer policies directly from the Epic environment.

How does Klivira address common denial reasons for neurology PAs, specifically step therapy?

Klivira incorporates AAN-guideline-aware step-therapy logic directly into the PA workflow. For MS DMTs and CGRP biologics, it ensures that required prior trials are documented and submitted, proactively mitigating denials based on step therapy non-compliance.

Is Klivira's integration with Epic Orchestrate compliant with data security standards for PHI?

Klivira adheres to stringent data security and privacy standards, including HIPAA, when handling ePHI within the Epic Orchestrate environment. Our platform is designed to protect sensitive patient information throughout the prior authorization process.