For Providers
Prior authorization and medical necessity review support that’s transparent, criteria-driven, and easy to work with—so you can focus on care.
Predictable Turnaround
SLA-driven decisions with clear notifications at each step. Typical determinations within defined windows based on case type and plan rules.
Criteria & Rationale
Reviews follow plan policy using evidence-based guidelines (e.g., InterQual/MCG) and CMS/NCQA-aligned processes. Rationale provided on all adverse outcomes.
Easy Peer-to-Peer
Fast scheduling for peer discussions when needed; clear documentation of outcomes.
Review Services
- • Prior authorization (inpatient, outpatient, diagnostic)
- • Concurrent & retrospective review
- • Post-acute level of care / site-of-care review
- • DME, therapy, and ancillary services
- • Appeals support & peer review coordination
Compliance & Standards
HIPAA safeguards; CMS/NCQA/URAC-aligned workflows; audit-ready logs and time-stamped determinations. Clinical staff operate under payer policies and delegated oversight.
Scope
We do not provide medical care. Coverage decisions follow plan benefits and policies. Treating providers maintain clinical responsibility for patient care.
Submit & Track a Case
1) Submit
Send requests through the plan portal or securely via humanresources@coordinatehomecare.com.
2) Review
RN/clinician review against plan policy & guidelines; P2P scheduled if required.
3) Determination
Determination issued to provider per SLA with rationale and next-step options.