Implementing Da Vinci PAS in New Hampshire for Prior Authorization Automation

The Pre-PAS Landscape for New Hampshire Providers

Before the adoption of Da Vinci PAS, prior authorization workflows for New Hampshire providers often rely on disparate payer-specific portals and manual processes. Submitting clinical documentation typically involves uploading unstructured PDFs or faxes, leading to delays and inconsistent processing across various commercial and Medicaid managed care plans operating in the state. This fragmented approach burdens administrative staff and extends decision turnaround times.

Operational Consequences of Traditional PA in New Hampshire

• Per-payer custom integration for each provider portal, requiring unique API code and authentication flows.
• Unstructured clinical attachments submitted as PDFs or scanned documents, limiting automated review by payers.
• No standardized response semantics, necessitating independent mapping of each payer's status taxonomy.
• Slow decision turnaround for clinical-necessity reviews due to manual parsing of unstructured documentation.

Klivira's Da Vinci PAS Implementation for New Hampshire Healthcare Systems

Klivira's platform leverages the HL7 Da Vinci Project implementation guides to standardize prior authorization for New Hampshire providers. Our solution integrates Da Vinci CRD for coverage discovery at order entry, Da Vinci DTR for structured documentation assembly, and Da Vinci PAS for FHIR-based submission and response. This end-to-end automation streamlines the PA process, from initial order to final decision, across all payers supporting these standards.

Automated Workflow with Klivira's Da Vinci PAS in New Hampshire

• Pre-PA coverage discovery via Da Vinci CRD (`davinci-crd-ig`) at order entry, returning structured coverage requirements.
• Documentation assembly via Da Vinci DTR (`davinci-dtr-ig`), populating structured questionnaires from EMR FHIR data.
• PAS submission of a FHIR `Claim` resource with structured clinical documentation via the `$submit` operation (`davinci-pas-ig`).
• Synchronous or asynchronous receipt of a standardized `ClaimResponse` resource, parsed into a uniform workflow state.
• Status tracking through PAS inquiry operations or webhook events, ensuring real-time decision visibility.
• Decision write-back to the EMR as a structured outcome, including authorization numbers and conditions.

Navigating CMS-0057-F and Da Vinci PAS Adoption in New Hampshire

The CMS-0057-F rule mandates that impacted payers—including Medicare Advantage, Medicaid managed-care, CHIP managed-care, and QHP-on-FFM plans—implement a Prior Authorization API by January 1, 2027. This FHIR-based API requirement aligns directly with Da Vinci PAS conformance. Klivira's platform is designed to support New Hampshire providers through this transition, operating against payers in various stages of PAS conformance, from test sandboxes to production endpoints. We track per-payer applicability under CMS-0057-F, ensuring compliance with mandated decision timeframes.

Addressing Key PA Failure Modes for New Hampshire Healthcare Systems

Klivira's Da Vinci PAS implementation directly addresses common failure modes encountered by New Hampshire healthcare organizations. By replacing per-payer custom integrations with a uniform FHIR operation interface, we significantly reduce maintenance overhead. Structured documentation submission via DTR eliminates the inefficiencies of PDF attachments, enabling faster payer-side review. Our system also standardizes inconsistent response semantics, providing a single workflow state taxonomy regardless of the payer, enhancing clarity and accelerating processing.