Prior Authorization Services

Obtaining state authorization prior to Medicaid in-patient services can be complex and time-consuming. nThrive’s centralized team of skilled clinicians, registered nurse auditors and certified coders can save hospital case managers valuable time, conducting concurrent medical necessity reviews to help coordinate authorizations. In addition, we’ll conduct retrospective reviews to appeal denied days or secure authorizations on newly covered Medicaid recipients.

The result is quicker access to cash and a decrease in denials.

  • Clinical experts with a proven track record of obtaining authorization for medically necessary care
  • Accurate documentation on the level of care (setting and days) to justify episode costs
  • Quicker access to cash; decrease in denials
  • Approximately 200 clinicians, including specialized nurses and physicians, with expertise to defend challenges on medical authorization of care