Six services, run by staff who work managed-care authorizations daily. Each one exists to close a specific gap where facilities lose covered days or money — not as a generic add-on.
Before a resident is admitted, we confirm exactly what their managed care plan covers — network status, authorization requirements, and any conditions on the benefit — so your admissions team isn't guessing or discovering a coverage gap after the fact.
We secure the initial authorization with the managed care plan ahead of or at admission, so the resident's stay is covered from day one and admission doesn't stall waiting on paperwork.
As a resident's care needs evolve, we prepare the clinical review and attend the plan's utilization review meeting directly — arguing for every additional day the clinical picture supports, so your DON or business office isn't pulled into a call with the payer.
When a plan issues a Notice of Medicare Non-Coverage, timing is everything. We file the NOMNC correctly and, where the clinical picture supports it, file the appeal within the required window — protecting the resident's right to continued coverage while it's reviewed.
We identify and manage Part B carve-out billing for services outside the primary managed care benefit, so those services get billed correctly instead of absorbed into the facility's per diem or missed entirely.
Every managed care claim is reviewed against the resident's actual acuity and documentation to pursue the highest appropriate reimbursement level — not just the first rate a plan offers.
Tell us about your facility's payer mix and current process — we'll show you exactly where Palisades fits in.
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