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Prior authorization
Prior authorization is its own seat. A care coordinator who is also rooming patients will miss the renewal. We confirm the benefit, submit the authorization, track approved units and visits, and start the renewal before the authorization expires. The clinician is not calling the payer between patients.
The work
- - Confirm the benefit and the auth requirement before care starts
- Submit prior authorization requests with the documents the payer asks for
- Track approved units, visits, and end dates
- Start renewals before the authorization runs out
- Tell the scheduler when a visit is not yet authorized
What we do
- - A status log the owner can read
- Renewal dates on a calendar, not in an inbox
- Coordination with scheduling so unauthorized visits are not locked in
What we do not do
- - Deciding what treatment is medically necessary
- Guaranteeing a payer will approve care
- Appealing a clinical denial without the treating clinician’s note
Outcomes
- - Authorizations are filed instead of discovered at the visit
- Units are visible before they hit zero
- The schedule is not filled with visits that cannot be billed
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