This client is a mid-sized home care provider in the United States. They offer a wide range of home care services including skilled nursing services, physical therapy and occupational therapy.
Red Road Health Solutions offers clinical and non-clinical business solutions to home healthcare providers and understands payor specific, federal, and state requirements for pre-authorization, as well as providing the full scope of Revenue Cycle Management Services.
Red Road Health Solutions’ experts in pre-authorization verify the eligibility and benefits of the assigned patients. Based on eligibility and benefits, they follow up with the payor by sending the required medical documents (485, clinical notes and visit notes and the payor-specific authorization form). Red Road also follows up with the payor to check the status of the request. Once the request has been approved, the approval letter is uploaded to the patient’s file and Red Road contacts the client’s relevant office(s) to let them know how to proceed.
In case of any held or denied authorization Red Road follows up with the payor via calls in order to identify the actual cause and coordinate with client, taking any further required information and submitting the appeal.
We also raise extension of authorization in a timely fashion
From the date of request, Red Road is required to obtain authorization based on payor specific timelines. This includes, on occasion, raising authorization within 24 hours for this client and prioritizing their request.
Red Road Health Solutions helped the client obtain prior approval by setting deadlines on a caseby-case basis. This resulted in the client receiving appropriate payments for the services rendered. It has also lowered the number of denials by 12 %, over a period of 14 months. Red Road helped this client apply for authorization on time, increase the clean payment ratio, reduce rejections, and helped with support for on-site workforce issues.