Every authorization is reviewed independently, and cross referenced with your facilities Managed Care contract and the care provided for each patient – to ensure that the appropriate highest level of reimbursement is approved.

For patients receiving IV antibiotics, wound care, or expensive medication that is contractually eligible for a higher rate of reimbursement (for the patient’s whole stay or specific dates of services administered) – Case Managers obtain authorizations at the highest appropriate rate.

 

Expensive medications alerts are reviewed to identify potential carve outs for expensive/specific medications.

 

Patient stays are closely monitored and there is a constant focus on denial management – The goal is to understand the facility’s discharge plan and obtain authorization through discharge.