Managed Care & MCO Billing
Complete prior authorization management, concurrent reviews, and denial appeals for all major Illinois managed care organizations and Medicare Advantage plans.
Our Services
Additional Details
Tell us about your facility’s managed care billing challenges or MCO authorization needs.
Complete MCO Billing for Every Illinois Managed Care Plan
Managed care billing is the fastest-growing and most complex segment of the Illinois SNF payer mix. Every major MCO — Meridian, Molina, IlliniCare, Centene, BCBS Illinois, and all Medicare Advantage plans — operates under its own authorization rules, concurrent review timelines, and billing requirements. A missed prior authorization, a late concurrent review, or a non-standard claim format can result in a full-episode denial worth thousands of dollars per resident.
LTC Billing manages the entire MCO revenue cycle — from initial prior authorization through final payment — so your team is never chasing authorizations, missing review deadlines, or leaving managed care revenue on the table due to administrative errors.
What’s Included
Prior Authorization Management
We initiate, track, and follow up on prior authorizations for all Illinois MCOs and Medicare Advantage plans — ensuring no resident is admitted or continues care without the required authorization in place.
Concurrent Review & Length-of-Stay Management
We manage all concurrent review submissions on schedule, provide payers with the clinical documentation they require, and appeal any reduction in authorized days before it affects your billing.
MCO-Specific Claim Formatting & Submission
Every MCO has unique claim formatting, modifier, and submission requirements. We build and submit claims to each payer's exact specifications — eliminating technical rejections caused by non-standard formatting.
Medicare Advantage Plan Billing
We manage all Medicare Advantage plans separately from traditional Medicare — tracking plan-specific authorization requirements, benefit structures, and coordination-of-benefits rules for each enrolled resident.
MCO Denial Appeals & Underpayment Recovery
Every MCO denial is reviewed immediately for clinical or administrative cause, appealed with full supporting documentation, and tracked through every level of the appeals process until resolved.
Our Process
01
Admission Authorization Request
We initiate prior authorization with the MCO at admission and confirm approval before the first billable day.
02
Concurrent Review Submission
We submit concurrent reviews on schedule with required clinical documentation to maintain authorized days.
03
MCO Claim Submission & Tracking
Claims are submitted to each MCO in their required format and tracked through adjudication daily.
04
Payment Posting & Denial Appeals
Remittances are posted and every denial is appealed with full documentation within 24 hours of receipt.
Why Specialized MCO Billing Matters for Illinois SNFs
Managed care now accounts for a growing share of the Illinois SNF payer mix — and it is the segment where billing errors are most costly. A single missed prior authorization can result in a full-episode denial, meaning the MCO refuses to pay for the entire stay rather than just the unapproved days. A late concurrent review can reduce authorized days retroactively, creating significant underpayments that are difficult to recover after discharge. For facilities with 20 or more MCO residents, these errors can represent tens of thousands of dollars in monthly revenue loss.
LTC Billing’s MCO specialists understand each major Illinois plan’s authorization process, review timeline, and appeal requirements — because we work with them daily across multiple facilities. We track every authorization, every review deadline, and every pending appeal in real time, so your facility’s MCO revenue is protected from the moment a resident is admitted through the final payment post.