Prior Authorization Services
End-to-end prior authorization management across Medicare Advantage, Medicaid, and Commercial Payors to eliminate care delays.
Service Scope & Methodology
As Medicare Advantage plans continue to capture market share, managing prior authorizations and concurrent visit extensions has become a critical administrative burden for home health agencies. Four Pillars takes full ownership of the prior authorization lifecycle. We compile clinical packets, submit through payor portals, track authorization status daily, handle peer-to-peer review scheduling, and immediately file expedited appeals on denied visits.
Key Scope of Work & Clinical Deliverables
- 01
Initial Prior Authorization Submission
Rapid clinical packet preparation and portal submission upon patient admission to secure prompt visit authorizations.
- 02
Concurrent & Re-Authorization Filings
Monitoring approved visit thresholds and submitting timely extension requests backed by updated therapy and nursing progress notes.
- 03
Payor Portal Daily Tracking & Follow-Up
Active monitoring across Availity, NaviNet, Optum, Humana, UnitedHealthcare, and regional Medicaid portals to prevent lapse of coverage.
- 04
Letter of Medical Necessity (LMN) Drafting
Drafting authoritative clinical letters of medical necessity tailored to specific payor coverage criteria and policy guidelines.
- 05
Peer-to-Peer Review Preparation
Organizing concise clinical briefing summaries for agency clinical directors and physicians prior to medical director reviews.
- 06
Denial Appeals & Reconsideration
Immediate generation and filing of Level 1 and Level 2 appeals for wrongful care limitations and technical denials.
Supported Electronic Health Records (EHRs)
Our teams work natively inside your agency's existing EHR environment using secure, direct-access credentials with zero disruption to field clinicians.
KanTime
AxxessDevero (MyUnity)
Compassus
Epic
HCHB (Homecare Homebase)
MatrixCare (Brightree)
MEDITECH
Netsmart
WellSky (Kinnser)HealthWyse