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.
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