Case Study: Enhancing Efficiency and Revenue Through PennyPack Group's Prior Authorization Expertise

Client Profile:

Multiple Skilled Nursing Facilities (SNFs) including St. Lukes SNF, Five Oaks SNF, Aiken SNF, and others, face challenges in managing the complex and time-sensitive process of securing prior authorizations from various insurance providers.

Challenges Faced by SNF Operators:

  1. Delayed Authorizations: Manual tracking led to missed deadlines, causing revenue loss.

  2. Complex Insurance Protocols: Each insurer had unique submission requirements and follow-up processes.

  3. Administrative Burden: Staff spent excessive hours managing authorizations, diverting attention from patient care.

  4. Denials and Revenue Loss: Lack of standardization increased the risk of denials and delayed reimbursements.

PennyPack Group’s Solution:

1. Centralized Authorization Tracking:

  • Using a unified tracking system, PennyPack ensures real-time updates on every patient’s authorization status.

  • All critical details—such as submission dates, insurance portals, authorization numbers, and notes on next required documents (NRDs)—are logged, preventing lapses in follow-ups.

2. Expertise Across Insurers:

  • Deep familiarity with insurance portals like Availity, NaviHealth, CareSource, and UHC, allowing for faster submission and approval processes.

  • Maintains a Master NPI List for seamless communication with facilities and physicians, reducing time wasted on administrative hurdles.

3. Proactive Authorization Management:

  • Advance Tracking of Expiration Dates: Prevents lapses in coverage and ensures continuity of patient care.

  • Automated reminders for critical dates like NRDs and re-certifications, reducing the risk of delayed payments.

4. Improved Financial Outcomes:

  • Reduction in denied claims by ensuring all documents meet insurer requirements before submission.

  • Faster reimbursement cycles by minimizing authorization backlogs.

  • Maximized occupancy rates by accelerating patient admissions through quicker insurance approvals.

Results:

  • 40% reduction in denied authorizations.

  • 30% faster turnaround from submission to approval.

  • Significant cost savings on administrative overhead, enabling staff to focus on patient care rather than paperwork.

Why Choose PennyPack Group?

  • Specialized Expertise: We understand the intricacies of SNF authorizations and insurer protocols.

  • Customized Tracking: Tailored solutions for each facility to meet its unique workflow needs.

  • Maximized Revenue: More approvals, fewer denials, and faster payments.

Partner with PennyPack Group and transform the way your facility handles prior authorizations—streamlining processes, reducing delays, and boosting your bottom line.