Payer types we handle; Commercial, Managed Medicare (Medicare Advantage), Workers Comp, VA Plans, No Fault, Medicaid Managed Care (skilled), Secondary/Copayment, & MLTC/MLTSS/Long-Term Custodial payers.
Comprehensive Case Management Includes:
Eligibility Verification & Prior Authorizations
We work directly with your admissions department to verify insurance eligibility, assess the appropriate level of care, and submit prior authorization requests in a timely manner. By identifying coverage requirements early and ensuring the necessary documentation is in place, we help prevent avoidable admission delays and streamline the authorization process.
Centralized Patient Review
We review each patient’s clinical record, diagnoses, care plan, and supporting documentation—streamlining all communication to a single point of contact. Our team also works with facility staff to ensure clinical documentation accurately supports the patient's medical necessity, level of care, and ongoing treatment needs.
Contract-Aligned Authorization Review
Absolute Authorizations' case managers independently review each authorization and cross-reference it with the care provided to ensure the highest appropriate level of reimbursement is approved. Documented rationales are provided for every level obtained to ensure clear, auditable data.
Proactive Denial & Appeal Management
We anticipate potential denials, communicate directly with insurance case managers, and initiate appeals, securing the proper length of stay for the patient. When a denial occurs, we support staff by reviewing the payer's rationale, explaining the patient's applicable appeal rights, and gathering and submitting supporting documentation. We track appeals and coordinate with your team to determine the appropriate next steps.
Concurrent Reviews & Continued Care Advocacy
We monitor authorization timelines and submit concurrent reviews with the appropriate clinical documentation to support continued coverage. Working directly with payer case managers and your clinical team, we advocate for medically necessary care, helping patients receive the appropriate level and duration of treatment through discharge.
Authorization Tracking & Timely Communication
All authorization details are tracked and conveyed to your billing department promptly to prevent gaps, missed days, or denied claims. Our team maintains clear communication between clinical and billing departments to ensure authorization details, approved levels of care, and payer determinations are accurately documented and available when needed.
Thanks to Absolute Authorizations I have a forever support group, and I am so grateful to be a part of this team with them here by my side."
Deb K. Social Worker- Lake Placid Health & Rehabilitation Center
