Home health prior authorization, handled before the visit
Our AI agents resolve the requirement at referral, assemble, submit and track each prior authorization for your home health or hospice; our experts set the rules beside your team.
Prior authorization work, in the order our study ranks it for automation
- Authorization-to-delivery reconciliationIn the top ten of 169 workflowsWorth it, ready now
- Pre-claim review package assembly and affirmation tracking in the review-choice statesIn the top half of 169 workflows
- Urgent and expedited requestsIn the lower half of 169 workflows
- Authorization and review outcome capture and payer-rule memoryIn the lower half of 169 workflows
- Peer-to-peer review scheduling and preparationIn the lower half of 169 workflows
Your top three on this list, ranked against your agency's own numbers.
Talk about one workflow
Authorization work costs your agency before the payer ever denies
Prior authorization and review work leaks money in three places: the schedule, the referral desk and the package.
Visits past the approval
The scheduler finds the exhausted authorization after the visits, and the claim denies.
Requirements missed by plan
Coordinators check payer sheets and memory, and plan-by-plan rules get missed.
Packages assembled by hand
A clerk hunts the record for each request, and non-affirmations resubmit late.
Filed ahead of the schedule, chased by no one
Three workflows that keep your agency's approvals ahead of the schedule, run by our AI agents with our experts beside your team.
Visits stop going out past the approved count
The scheduler finds the exhausted authorization after the visits, and the claim denies. Our AI agents check every visit against the ledger each day and request extensions before the visits; our experts handle the exceptions.
- No visit scheduled beyond the approved window
- Extensions requested before the window closes
- Added disciplines authorized before delivery
Pre-claim packages that affirm the first time
Clerks hand-assemble packages; non-affirmations resubmit after the period closes. Our AI agents build to the review contractor's checklist and track the affirmation rate; our experts handle judgment calls.
- Packages assembled to the review contractor's checklist
- Affirmation rate visible per branch and period
- Non-affirmations resubmitted inside the period
Each plan's rule answered at the referral desk
Coordinators check payer sheets and memory, and plan-by-plan requirements get missed. Our AI agents resolve the requirement at referral from a maintained payer-rule set; our experts keep it current with what your payers enforce.
- Requirement resolved at referral, citation shown
- Every payer and plan rule in one place
- Your coordinators stop checking payer sheets
How our experts and AI agents run this work
Moative's engineers and revenue-cycle specialists join billing, intake and clinical teams, one method starting with what you bring.
01What you bring
Your agency brings the authorization workflow as it runs today, your payer mix and your systems. Our AI agents run beside your EMR.
02What our experts do
Our experts work backwards from the outcome you want, fix the data, and set the rules our AI agents check against.
03What our AI agents do
Our AI agents check visits against the authorization ledger, assemble packages, resolve payer rules and flag what you decide.
What our experts and AI agents do that software cannot
You are weighing this against tools you already pay for. Here is what each one does with authorization work, and where it stops.
Custom AI made for your agency
Our engineers sit with your coordinators, watch the work, and build AI agents for it. Your agency keeps its EMR, your staff make the calls, and every rule stays changeable.
- Runs beside your EMR and payer portals
- Your staff review every flag and decide
- Pay for the workflows you automate
Billing and RCM software
Good at organizing the authorizations you track. It usually runs the same steps for every agency, so each payer's quirks stay manual.*
The EMR's own billing module
Good at staying connected to the chart. It usually stops at the standard path; each payer's own requirements stay on your staff.*
An outsourced billing company
Good at taking the authorization pile off your desk, usually per claim. Their people follow their playbook; your urgency waits.*
* Each line above describes a category as commonly sold; any given vendor or product will differ, and terms vary by provider and contract.
Cost, the EMR and who decides, answered before you say yes
How is this priced?
Pricing moves when automated workflows do, independent of staff count. Adding users costs nothing.
Do we replace our EMR?
No. Our AI agents run beside your existing EMR, clearinghouse and payer portals, reading and writing back. Your agency keeps its systems and its data.
Who makes the clinical calls?
Your staff. Our AI agents check, flag and route; your team reviews every flag and decides. The software makes no clinical decisions.
What must we have ready?
A named workflow to start with, someone on your team for questions, and time for our experts to observe the work before anything is automated.
Every authorization known, filed and tracked
You talk with an engineer about one workflow: where it hurts, what it costs, and what our AI agents take over. Your team keeps the decisions.
Common questions
Do Medicare Advantage plans need prior authorization?
Yes, most do. Medicare Advantage plans set their own authorization rules for home health, so the answer is per plan; our AI agents resolve it at referral with the citation shown.
Does home health require prior authorization?
It depends on the payer and the state. In the Review Choice Demonstration states, agencies choose pre-claim review or postpayment review; Medicare Advantage plans set their own rules.
What is RCD in Medicare?
RCD is the Review Choice Demonstration for home health. In demonstration states, agencies choose pre-claim or postpayment review; a 90% affirmation rate on at least 10 requests unlocks reduced-review options after six months.
Who is the Medicaid waiver authorized by?
The state sets it. Federal rules require each service in the person-centered service plan to be separately defined, with scope, amount, frequency and duration set by the state, and renewals recur.
What does it mean when a medical claim is denied for medical necessity?
The payer judged the record did not show why the service was needed. Our AI agents assemble the request from your record and your clinical manager approves the narrative before it goes out.
Is a pre-claim review the same as a prior authorization?
No. A prior authorization is the payer's approval before services; pre-claim review is a Medicare documentation review before the final claim, used in the Review Choice Demonstration states. Our AI agents track both.
The full study, PDF · 636 KB
Take the documentation fights once the plumbing works
The highest-value work left on the table is hard for honest reasons: the data is messy and the rules bend to the patient in front of you.