Obtaining, Managing & Tracking Authorizations.

Working directly with the Admissions department, our case managers “take over” the authorization management once a managed care patient admits. This includes authorizations for Commercial, Medicare Advantage, Workers Comp, No Fault, Medicaid Managed Care (skilled), Secondary/ Copayment, & MLTC/MLTSS/Long-Term Custodial payers. 

Comprehensive HMO Case Management Includes:

• Reviewing each HMO patients’ medical records, diagnoses, care plan, and streamlining all communication to one point of contact.

• Independently reviewing each patient’s authorization and cross referencing it to the care provided to ensure the appropriate level and highest rate of reimbursement is approved as per the HMO contract.

• Being proactive with denial management and using our experience in HMO case management to communicate with Insurance case managers.

• Tracking all authorizations and ensuring that auth details are properly conveyed to billing department – in a timely manner.