Are Authorization Denials Costing You Thousands?
In Long-Term Care, services delivered without pre-authorization are services given away for free.
What Is Prior Authorization & Case Management for Long-Term Care?
Prior authorization and case management is the process of securing payer approval before care is delivered, then managing ongoing utilization review to keep that approval in place for the length of a resident’s stay. For skilled nursing and assisted living facilities, this covers everything from the initial authorization request through concurrent review, appeals, and retro-authorization if a case is missed. LTCPro provides this service to facilities across the United States.
High Cost Denials
Lack of pre-authorization is one of the Top 3 reasons for claim denials, and these denials are almost 100% unrecoverable. Nearly all Medicare Advantage plans require prior authorization for SNF stays, and most appealed denials get overturned, a strong sign the initial denial was wrong, which is why appeals and retro-authorization are core to protecting revenue.
Administrative Effort
Providers spend an average of 30-60 minutes on the phone per authorization request.
See how many hours your staff loses to hold music. Get a free authorization process review and find your biggest bottleneck.
We Get Your Care Approved—Guaranteed
LTCPro's Case Management & Authorization service acts as your expert front-line defense against authorization denials. Our team of specialists navigates the complex payer landscape for you, securing the approvals you need before care is delivered.
Navigating the complexities of healthcare authorization is essential for long-term care facilities, such as Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs). LTCPro’s specialized Authorization Services are crafted to streamline the process of obtaining necessary approvals for medical services. By minimizing administrative burdens, these services ensure that residents receive timely and appropriate care without unnecessary delays. This efficiency is crucial in maintaining high standards of care and compliance with healthcare regulations.
Timely access to medical services can significantly impact residents’ health outcomes. By efficiently managing the authorization process, LTCPro helps reduce delays in care delivery, enhance compliance with insurance requirements, and improve overall operational efficiency.
Our Authorization Services Include:
- Pre-Authorization Management: We manage the entire pre-auth process, from submitting initial requests to following up on status and securing the approval number.
- Utilization Review (UR): We handle concurrent reviews with payers to ensure continued-stay authorizations, preventing gaps in payment.
- Retro-Authorization & Appeals: If a case is missed, our team has the expertise to fight for retroactive authorizations and appeal clinical denials.
- Payer Relations: We build relationships with payer case managers, learning their specific criteria to streamline your approvals.
- Authorization Tracking: You get a clear, shared dashboard of all pending, approved, and denied authorizations.
Stop chasing approvals on hold. Talk to an authorization specialist and see what a dedicated payer relations team can do.
From Referral to Reimbursed Care
Free Process Review
1 We analyze your current intake and authorization workflow to identify your biggest bottlenecks and denial hotspots.
Workflow Integration
2 We create a simple, seamless process for your admissions team to send us new patient referrals.
Proactive Management
3 Our team immediately takes over all communication with payers, securing auths and managing UR reviews.
Clear Reporting
4 We provide real-time updates on all authorization statuses, so your clinical and billing teams are always in sync.
Our Comprehensive Long Term Care RCM Services:
LTCPro offers a full suite of authorization services tailored specifically for long-term care facilities. Our services include:
- Prior Authorization Management: We handle the entire prior authorization process for various medical services and treatments, ensuring that all necessary approvals are obtained before care is delivered. This includes submitting requests to insurance providers and following up on pending authorizations.
- Insurance Verification: Our team conducts thorough verification of residents’ insurance coverage to determine eligibility for services. This step is crucial in preventing billing issues and ensuring that residents receive the care they need without unnecessary delays.
- Claims Submission and Follow-Up: LTCPro manages the submission of claims to insurance providers, ensuring that all required documentation is included. We also follow up on outstanding claims to expedite the reimbursement process, reducing the time between service delivery and payment.
- Regulatory Compliance: We ensure that all authorization activities comply with federal and state regulations, as well as industry standards. This commitment to compliance helps facilities avoid penalties and maintain operational integrity.
- Reporting and Analytics: Our services include generating detailed reports on authorization activities, including approval rates, turnaround times, and service utilization. These insights support decision-making and help facilities identify areas for improvement.
- Coordination with Healthcare Providers: We work closely with healthcare providers and specialists to facilitate the authorization process, ensuring that all necessary information is gathered and submitted in a timely manner.
- Appeals Management: In cases where authorization requests are denied, LTCPro assists facilities in navigating the appeals process. We provide support in gathering necessary documentation and submitting appeals to insurance providers.
Benefits of Partnering with LTCPro for Authorization Services
- Improved Care Access: Our efficient authorization processes ensure that residents receive timely access to necessary medical services, improving health outcomes.
- Enhanced Compliance: Our expertise in regulatory requirements helps your facility maintain compliance, reducing the risk of audits and penalties.
- Increased Operational Efficiency: Streamlined authorization processes minimize delays and administrative burdens, allowing your staff to focus on resident care.
- Better Financial Performance: By expediting claims submission and follow-up, we help improve cash flow and reduce outstanding receivables.
A 2026 Rule Change Is Shortening Payer Response Times
As of January 1, 2026, Medicare Advantage plans, along with Medicaid managed care and CHIP plans, are required to respond to standard prior authorization requests within 7 calendar days, down from the 14-day window many plans previously used, under the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Expedited requests must now be answered within 72 hours. Faster turnaround cuts both ways for facilities: it can mean quicker approvals, but it also raises the cost of a missed or incomplete request, since payers now have less room to grant extensions, and less time exists to catch and correct errors before a denial is issued.
Ready for faster turnaround, not more denials? Get a free review of your current authorization process before the new rules take effect.
LTC Authorization Reports & Analytics:
- Authorization Approval Reports: Documentation of all prior authorization requests and their outcomes.
- Service Utilization Reports: Analysis of services provided to residents, helping identify trends and areas for improvement.
- Claims Status Reports: Updates on the status of submitted claims, including pending, approved, and denied claims.
- Compliance Reports: Reports ensuring adherence to regulatory requirements and industry standards.
- Appeals Management Reports: Documentation of denied authorizations and the status of appeals submitted.
In-House vs. Outsourced Authorization Management: Which Is Right for Your Facility?
Authorization denials are unlike most other billing problems: once care is delivered without approval, the revenue is almost never recoverable. That makes this one of the highest-stakes build-vs-buy decisions a facility makes.
Not sure how many authorizations are slipping through?
Book a free process review and see your denial hotspots.
Frequently Asked Questions About Prior Authorization & Case Management
Do Medicare Advantage plans require prior authorization for skilled nursing facility stays?
Yes. The large majority of Medicare Advantage enrollees are in plans that require prior authorization for skilled nursing facility stays, making it one of the most common authorization requirements long-term care facilities deal with.
Why do so many skilled nursing facility prior authorization denials get overturned on appeal?
Federal oversight reviews have found that when SNF prior authorization denials are appealed, the vast majority are overturned in the facility’s favor. This suggests a meaningful share of initial denials are incorrect from the start, which is why appealing denied authorizations, rather than writing them off, is often worth the effort.
What happens if we deliver care before a prior authorization is approved?
Care delivered before authorization is secured is typically not covered by the payer, and this type of denial is very difficult to reverse after the fact. This is why proactive pre-authorization management, rather than after-the-fact correction, is the most effective way to protect revenue.
What's the difference between prior authorization and utilization review?
Prior authorization is the approval obtained before care begins. Utilization review is the ongoing process of justifying continued care to the payer for as long as the resident’s stay continues, and a missed utilization review deadline can create a payment gap even after the initial stay was approved.
How long do Medicare Advantage plans have to respond to a prior authorization request?
Response timeframes are governed by CMS rules that have been tightening in recent years, with a 2026 rule change shortening the standard response window for Medicare Advantage plans. Exact timeframes can vary by plan and request type, so confirming current requirements against the latest CMS guidance is recommended.
Ready to Stop Losing Revenue to Authorization Denials?
Get a free authorization process review and find out exactly where denials are slipping through, before you write off another dollar.