Automating Prior Authorizations with Klivira and Cognizant TriZetto
Klivira seamlessly integrates with Cognizant TriZetto systems, transforming manual prior authorization processes into an automated, efficient workflow.
Revenue cycle leaders and prior authorization coordinators face increasing pressure to manage the complex, often manual, prior authorization landscape. While platforms like Cognizant TriZetto streamline many administrative and claims processes, the PA burden frequently remains a significant operational bottleneck, impacting staff productivity and financial outcomes. Klivira addresses this challenge by providing a dedicated automation layer that complements your existing TriZetto infrastructure.
The Prior Authorization Challenge within TriZetto Workflows
Even with robust clearinghouse and payer solutions like Cognizant TriZetto, prior authorizations often require extensive manual intervention. Staff must navigate disparate payer portals, interpret complex medical policies, and track submission statuses outside of core RCM systems, leading to delays, errors, and increased administrative costs. This fragmentation directly impacts claims processing and revenue realization.
Klivira's Strategic Integration with Cognizant TriZetto
Klivira extends the capabilities of your Cognizant TriZetto environment by automating the entire prior authorization lifecycle. Our platform ingests clinical data, intelligently determines authorization requirements, and automates submission and tracking, all while synchronizing critical status updates back into your operational workflows. This integration ensures a cohesive and efficient authorization process.
Key Benefits of Klivira for TriZetto Users
- Reduced Administrative Burden: Automate manual tasks, freeing PA coordinators to focus on complex cases.
- Accelerated Approval Times: Proactive submission and real-time tracking minimize delays.
- Improved First-Pass Approval Rates: AI-driven medical necessity checks and complete submissions reduce denials.
- Enhanced Data Visibility: Centralized dashboards provide a comprehensive view of all PA statuses.
- Optimized Resource Allocation: Reallocate staff from repetitive data entry to higher-value activities.
- Seamless Data Exchange: Ensure accurate and timely information flow between clinical and administrative systems.
Technical Integration and Data Exchange
Klivira leverages industry standards for secure and efficient data exchange with Cognizant TriZetto. This includes support for X12 278 (ePA) transactions, alongside API-based integrations for richer data synchronization. Our platform is designed to complement your existing data flows, ensuring clinical and administrative information required for prior authorizations is accurately captured and transmitted, minimizing manual data entry and potential errors.
Impact on Revenue Cycle and Patient Experience
By automating prior authorizations, Klivira directly contributes to a healthier revenue cycle for organizations utilizing Cognizant TriZetto. Faster approvals mean quicker service delivery and claims submission, reducing AR days and improving cash flow. Furthermore, a streamlined PA process minimizes appointment delays and unexpected denials for patients, leading to a more positive and transparent healthcare experience.
Preparing for Evolving PA Regulations
The regulatory landscape for prior authorizations is continuously evolving, with initiatives like CMS-0057-F aiming to standardize and accelerate the process. Klivira's agile platform is built to adapt to these changes, providing a future-proof solution that helps your organization remain compliant and efficient. Integrating with Klivira ensures your TriZetto-powered operations are ready for upcoming mandates and opportunities for further automation.
Frequently asked questions
How does Klivira specifically integrate with Cognizant TriZetto for prior authorizations?
Klivira integrates with Cognizant TriZetto to automate the prior authorization workflow. This involves ingesting patient and clinical data from your EMR (often facilitated by TriZetto's connections), processing it for authorization requirements, automating submission via X12 278 or payer portals, and then pushing status updates back into your operational systems. This creates a continuous, automated loop for PA management.
What types of data are exchanged between Klivira and TriZetto?
The data exchanged typically includes patient demographics, clinical information (diagnoses, procedures, medical necessity documentation), requested services, and prior authorization status updates. Klivira ensures that all necessary data points for a complete and compliant prior authorization request are captured and transmitted securely, leveraging existing data flows from your TriZetto-connected systems.
Will Klivira replace any existing prior authorization features within my Cognizant TriZetto setup?
Klivira is designed to augment and enhance your existing Cognizant TriZetto capabilities, not replace them. While TriZetto handles many aspects of claims and payer interactions, Klivira specializes in the deep automation and intelligent management of the prior authorization lifecycle. It acts as an intelligent layer that works in concert with your TriZetto solutions to drive greater efficiency in PA workflows.
How does Klivira ensure the security and privacy of PHI when integrating with TriZetto?
Klivira maintains strict adherence to HIPAA regulations and industry best practices for data security and privacy. All data exchanged between Klivira and your TriZetto-connected systems is encrypted in transit and at rest. Our platform is built with robust security controls, access management, and audit trails to protect ePHI throughout the entire prior authorization process.
Can Klivira handle prior authorizations for all payers accessible through Cognizant TriZetto?
Klivira's platform is designed for broad payer coverage, extending beyond just X12 278 transactions to include automation for web portals and fax submissions. While Cognizant TriZetto facilitates connections to numerous payers, Klivira's automation engine complements this by handling the specific, often manual, requirements of individual payers, ensuring comprehensive coverage for your prior authorization needs.
Related coverage
Ready to ship this workflow?
See how Klivira automates prior authorizations for your team.
Request a demo