Authorization Management

Mrs. Davis Is Authorized for 35 Hours. You're Scheduling 28. Her Authorization Closes in 18 Days.

Denise described the authorization problem to Jackie like this: 'This is the one that's costing you money right now and you might not even know it.' Nobody has time to compare authorized hours against scheduled hours for every patient every week. CareBravo does that automatically — and tells you before the revenue expires, not after.

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What Untracked Authorizations Cost

The Hours Were Approved. The Care Was Authorized. The Revenue Disappeared Anyway.

Jackie doesn't know her authorization utilization rate. She's never had time to sit down and run the comparison. Denise knows she has a problem — she's done the napkin math on a slow Sunday and didn't like the number — but she doesn't have a system that does it automatically, so it only happens every six weeks at best. For Tasha, who is choosing her first operational system: authorization tracking is the single most important function to have in place before your first patient. The habit of letting authorized hours expire starts at patient one. Breaking it at patient thirty is harder.

CareDrain™ recovered by this function — per month at 30 patients Estimates scale by patient count. Actual recovery depends on agency size and operational setup.
~$2,400 / month
How CareBravo Delivers It

Every Patient. Every Approved Hour. Watched Every Week — Without Anyone Running the Report.

CareBravo's authorization management function compares authorized hours against scheduled hours for every active patient, every week, automatically. When a gap opens — hours approved but unscheduled, an authorization window closing in 18 days, a patient whose care plan hasn't kept pace with their authorization — the alert surfaces. The patient's name, the unscheduled hours, the revenue at stake, the expiration date. You make the scheduling decision. CareBravo makes sure the gap is visible before it's permanent.

What arrives as completed work

Authorized hours compared against scheduled hours for every active patient, every week, automatically. Alerts showing patient name, unscheduled hours, revenue at stake, and authorization expiration date — surfaced before the window closes, not after.

What your team does instead

Review the utilization alerts. Schedule additional hours where clinically appropriate. Coordinate with case managers on authorization renewal before expiration. The authorization gap is visible — the scheduling decision is yours.

What connects to this function

Authorization management connects to scheduling — when a utilization gap is identified, the scheduling function can find available caregivers to fill the unscheduled hours before the authorization expires. It connects to billing — claims are reviewed against current authorization status.

What this looks like at your stage

At 30 patients: Jackie has never run a full authorization utilization analysis. The money is leaving without her seeing it. At 90 patients: Denise has done the napkin math on slow Sundays and doesn't like the number. Pre-launch: authorization tracking from the first patient means you never build the habit of letting approved hours expire. Tasha builds this right.

100+ agencies. 73% average revenue growth. No added back-office hires. The ~$2,400/month in Authorization Drain recovered at 30 patients is the largest single component of CareDrain. Agencies that track utilization systematically from the start never create this problem in the first place.

Questions

What Agency Owners Ask About Authorization Management

A prior authorization in home care is a Medicaid payer's formal approval for a specific patient to receive a specific number of care hours during a defined period. Authorization hours that are not scheduled and delivered before the authorization period expires cannot be billed retroactively — they disappear. Most Medicaid patients have authorizations that are renewed periodically, and unused hours in one authorization period do not carry over to the next.

Unused prior authorization hours expire at the end of the authorization period without recovery. If a patient is authorized for 35 hours per week and only 28 are scheduled, the 7 unused hours disappear when the authorization period ends. The agency cannot retroactively bill for authorized but undelivered care. This is the largest single component of CareDrain — approximately $2,400 per month at a 30-patient agency.

Tracking authorization utilization requires comparing each patient's authorized hours to their scheduled hours, every week, and flagging gaps before the authorization period expires. Manual tracking on spreadsheets is episodic — it only works when someone has time to run it. CareBravo's authorization management function runs automatically for every patient, every week, surfacing gaps before they become permanent revenue losses.

Based on Medicaid home care industry patterns, Authorization Drain costs approximately $2,400 per month at a 30-patient agency — approximately $80 per patient per month. At 90 patients, the loss is approximately $7,200 per month. These are estimates; actual losses depend on the agency's authorization utilization rate, payer mix, and Medicaid reimbursement rates in the state.

No. Once an authorization period ends, approved but undelivered hours cannot be billed retroactively. Retroactive authorization requests are possible in some limited circumstances but are not a reliable recovery mechanism for routine utilization gaps. The only way to recover Authorization Drain revenue is to prevent it — by tracking utilization continuously and scheduling approved hours before the authorization window closes.

Find Out How Many Authorization Hours Your Agency Is Leaving on the Table.

The diagnostic reviews your actual authorization records against your scheduling data — every patient, the utilization gap, the revenue at stake, the expiration dates. You see the number on your real data before you decide anything.

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What Authorization Drain costs and how it happens → See your full authorization drain estimate → How authorization connects to billing accuracy → How scheduling connects to authorization utilization →