Medical Prior Authorization Review

One of the specialized services that Adreima’s Clinical Auditing Team provides to hospitals across the country, including Florida-based hospitals, is managing the prior authorization of inpatient hospital Medicaid services. The process of obtaining authorization from the state’s contracted provider is often time consuming for hospital case managers.

Adreima provides a team of skilled Registered Nurse Auditors and Certified Coders that work with your staff to obtain clinical authorizations utilizing the team’s years of clinical experience as well as the appropriate Published Peer Reviewed criteria.

Our centralized team conducts medical necessity reviews concurrently to coordinate authorizations, with all activity documented in the hospital’s patient accounting system, providing real time access for your staff. In addition to obtaining the authorization, our expert team is able to conduct retrospective reviews to appeal denied days or obtain authorizations on newly covered Medicaid recipients. Our extensive reporting provides recommendations for process improvement to reduce future reimbursement problems.

Benefits include:

• Authorizations completed in a timely manner to ensure all requirements are met for Medicaid reimbursement.
• Identification and resolution of clinical concerns in the charting to ensure correct authorizations are requested at the time of service.
• With Adreima handling the Medicaid Authorization process, case managers are able to focus on their role in the delivery of quality patient care.
• Secure data transfer of medical records and notation in hospital systems for seamless interaction with on-site staff.

With over 20 years of experience providing clinical and technical review service for our clients, Adreima provides a holistic view of these claims, and works to ensure that the hospital will be reimbursed every dollar they are entitled to and without unnecessary delay.