Cutting Prior-Authorization Turnaround for a Medicare Advantage–Heavy Caseload
Multi-payer home health agency (~60% Medicare Advantage) · Western U.S.
6.2 → 1.8 days
Avg Auth Turnaround
92%
Fewer No-Auth Denials
$740K
Revenue Protected / yr
100%
Authorization Tracking
How automating prior-auth data capture and deadline tracking cut authorization turnaround and eliminated most no-authorization denials for an MA-heavy caseload.
The Challenge
A home health agency with roughly 60% of its census in Medicare Advantage plans was losing revenue to a problem traditional Medicare never created: prior authorization. Every plan had different authorization rules, forms, and timelines, and the team tracked them in a patchwork of spreadsheets and inboxes. Because authorizations were slow and easy to lose track of, care sometimes began before an authorization was confirmed — and those visits turned into no-authorization denials that were nearly impossible to appeal. Slow turnaround also delayed starts of care, frustrating referral sources and clinicians alike. The agency had no single view of which authorizations were pending, approaching a deadline, or already expired.
Our Solution
We centralized prior authorization into a single tracked workflow. AI intake extraction reads inbound referrals and clinical documentation and pre-populates each payer’s authorization request, so coordinators start from a complete draft rather than a blank form. A shared authorization tracker surfaces every pending request, flags approaching deadlines, and prevents visits from being delivered against a missing or expired auth. We paired the automation with a payer-rule library — each plan’s requirements documented and kept current — and human coordinators who verify and submit every request. The combination collapsed turnaround time and closed the gap that had been converting delivered care into unbillable claims.