Revolutionizing Neurology Prior Auth with SMART on FHIR Integration

The Challenge of Neurology Prior Authorization

Neurology prior authorization is uniquely complex, driven by high-volume specialty drugs like MS disease-modifying therapies (DMTs), CGRP migraine biologics, and advanced imaging such as brain MRIs. These treatments often require extensive documentation, adherence to AAN Practice Guidelines, and frequent re-authorizations, creating significant administrative overhead for clinical teams.

Streamlining PA for High-Volume Neurology Treatments

Klivira's automation platform specifically targets the most PA-intensive areas in neurology. We streamline processes for MS DMTs, including step-therapy logic, and automate documentation for Alzheimer's anti-amyloid antibodies, ensuring all required amyloid confirmation and MRI screening protocols are addressed. This also extends to CGRP migraine prevention and Botox for chronic migraine, reducing manual effort.

Eliminating Context-Switching with SMART on FHIR

The core of Klivira’s solution for neurology is our SMART on FHIR integration, eliminating the need for clinicians or PA coordinators to navigate away from the EMR. By launching Klivira directly from within systems like Epic, Cerner, athenahealth, or MEDITECH, patient and encounter context is automatically transferred, preventing manual errors and significantly reducing the context-switching burden cited by the AMA.

FHIR-Native Data Exchange for Precision and Efficiency

Our platform leverages FHIR R4 to read US Core resources directly from your EMR's FHIR endpoint, ensuring accurate and comprehensive clinical data for PA submissions. This eliminates manual data transcription and screen-scraping, which are common sources of documentation gaps and denial reasons in neurology, particularly for complex requirements like EDSS scores for MS DMTs or headache diaries for CGRP biologics.

Key Benefits of Klivira's SMART on FHIR for Neurology PA

• **In-EMR Workflow:** Launch Klivira directly from Epic, Cerner, athenahealth, or MEDITECH for an integrated PA experience.
• **Automated Data Capture:** FHIR R4 reads patient and encounter data, eliminating manual entry and reducing errors.
• **Da Vinci PAS Compliance:** Supports Da Vinci CRD, DTR, and PAS for standardized coverage discovery, documentation, and submission.
• **Specialty-Specific Logic:** Incorporates AAN-guideline-aware step-therapy and documentation requirements for neurology.
• **Structured Write-Back:** PA decisions and status updates are written back to the EMR as structured FHIR resources.
• **Reduced Denials:** Addresses common denial reasons such as step therapy non-compliance and documentation gaps for high-cost neurology drugs.

Integrating with Payer and Clinical Guidelines

Klivira’s platform integrates with payer channels and policy libraries, using Da Vinci CRD for coverage requirements discovery at order entry and Da Vinci DTR for dynamic documentation questionnaires. This ensures that neurology-specific documentation, such as amyloid imaging results for Alzheimer's therapies or prior preventive trials for CGRP biologics, aligns with payer rules and AAN Practice Guidelines.