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Pediatric Authorization Requests Made Easy


Administrators and designated staff in home care organizations spend countless hours working on authorization requests. Tracking requests can be time-consuming and difficult to maintain, and most organizations have unfortunately experienced large write-offs that come with missing or late authorizations. Meticulous clinical documentation in a home care software provides easy and accurate tracking, and smart scheduling can reduce the pain level that authorizations can cause organizations.

Pediatric Authorizations Can Be More Difficult

As of 2020, approximately 10.2 million children (or 15% of all children in the United States) have special healthcare needs. However, in 2017 about half of the number of children with special healthcare needs received support services provided by Medicaid. The Medicaid program is jointly funded by states and the federal government and is administered by states. This means that every state Medicaid program is different, including the way that authorizations are handled.

Most states require an authorization prior to payment for services that these medically fragile children receive, such as private duty nursing (PDN). Still, the details of what is required for authorizations vary from state to state. One aspect that is common for all programs is the challenge that comes with documenting, submitting and tracking pediatric authorization requests.

How a Home Care Software Helps with Authorizations

Clinical documentation details the medical necessity, services provided and progress or decline of the client status that are essential for requesting coverage for the needed services. This documentation starts with the clinicians and caregivers in the home. Having an intuitive and easy-to-use home care software enables clinicians and caregivers to accurately capture and document all services provided in the home.

Simplifying the Authorization Request Process

A common example of supporting documentation for a pediatric authorization request is a suction log. Clinicians and caregivers may suction a pediatric client diagnosed with a respiratory disease process many times during a shift, often multiple times per hour. Having a quick and easy way to document each time this task is performed and submit that documentation to an insurance company or state Medicaid program helps demonstrate medical necessity and the frequency of interventions needed to prevent hospitalization of the child.

Once the request and all supporting documentation is submitted, accurate tracking of the authorization process is essential. Tracking when and what was submitted is important, but other timepoints should also be tracked, like when the authorization request can be submitted. Many Medicaid programs have specific time frames outlining when a new authorization for continued services can be submitted prior to the current authorization’s expiration date. Tracking this date is key to submitting the request as early as possible to reduce the risk of a current authorization expiring before a new one is received.

An Efficient Scheduling Process Is Essential

Historically, home care organizations track these dates using whiteboards, spreadsheets, sticky notes that move across a bulletin board and electronic calendar reminders. However, having an intuitive home care software that tracks expiration dates and alerts you at a specified time before the expiration is a huge benefit.

Scheduling only authorized visits or hours reduces the risk of providing unauthorized services and losing reimbursement. Using a software that displays authorized hours and alerts or prevents users from scheduling unauthorized visits is instrumental. Axxess Home Care has these features built in, to help make authorization request challenges a thing of the past.

Authorization tracking, scheduling alerts and seamless documentation features can assist with the dreaded authorization request process. Axxess Home Care is an enterprise home care software built by home care professionals with caregivers and administrators in mind.

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