Prior authorization for every post-acute EHR, concurrent review ready

Prior authorization in post-acute care runs as an ongoing clinical review rather than a single approval at admission. Whether the setting is a skilled nursing facility, a home health agency, or a hospice, the post-acute EHR (PointClickCare, MatrixCare, or WellSky, among others) holds the MDS, OASIS, or hospice documentation that a Medicare Advantage plan needs to authorize the stay. Flexbone reads those structured datasets, assembles the packet, and submits it through the payer portal or as an X12 278 electronic prior authorization transaction, then works the concurrent-review cycle that follows every few days. Each exchange happens inside HIPAA-covered systems, and this page walks each EHR and how the integration works.

PointClickCare

PointClickCare (PCC) is the dominant SNF and senior living EHR in North America with substantial share in assisted living and home health as well. PCC covers MDS, point-of-care clinical documentation, eMAR, rehab, and billing. Flexbone integrates via PCC\u2019s APIs and marketplace, reading resident census, MDS assessments, therapy minutes, wound documentation, and clinical notes. On the PA side, Flexbone assembles concurrent-review packets for MA plans and submits on the review cadence. See AI for PointClickCare.

MatrixCare

MatrixCare (ResMed) covers skilled nursing, senior living, home care, home health, and hospice through several integrated products (Clinical, CareHub, ResidentCare). Flexbone reads clinical and census data via the MatrixCare API, then handles the full Medicare Advantage cycle: admission PA for a SNF stay, concurrent review against continued skilled need every five to seven days, and discharge authorization. On the home health and hospice side, Flexbone pulls OASIS and certification data and maps each submission to the payer criteria (InterQual or MCG) before it goes out through the plan portal. For payer-specific rules, see Medicare and Medicaid PA.

American HealthTech (AHT)

American HealthTech (AHT) is a long-established skilled nursing EHR, common at mid-sized and regional SNF operators, covering MDS, clinical charting, and billing. Flexbone integrates through the AHT API or, where an API is not available, a browser agent that reads the resident chart directly. For prior authorization, Flexbone assembles the Medicare Advantage admission packet from the MDS and clinical notes, submits it to the plan portal or as a 278 transaction, and runs the five to seven day concurrent review that determines whether the skilled stay continues.

Netsmart myUnity

Netsmart myUnity is the unified platform covering senior living, home care, home health, and hospice after Netsmart consolidated the prior McKesson Homecare, Suncoast, and DeVero products. Flexbone reads clinical and authorization data across both post-acute and home-based settings. For home health, that means OASIS, the 485 plan of care, and the physician face-to-face note, aligned to the 30-day PDGM periods and to Medicare Advantage PA requirements. For hospice, Flexbone pulls the initial certification and recertification documentation and submits each authorization to the plan on its review cadence.

WellSky

WellSky is a leading home health and hospice platform, strong in long-term services and growing in post-acute. Flexbone reads OASIS, the 485 plan of care, physician face-to-face documentation, and visit logs directly from WellSky. For Medicare Advantage and commercial home health, Flexbone maps that documentation to the plan criteria, submits the authorization through the payer portal or a 278 transaction, and tracks it across the 30-day PDGM periods. For hospice, Flexbone prepares the initial certification and the 90-day and 60-day recertifications with the required LCD diagnosis documentation.

MDI Achieve

MDI Achieve (MDICampus) is deployed at mid-sized skilled nursing operators with an emphasis on clinical decision support and MDS accuracy. Flexbone reads the MDS, therapy minutes, and clinical notes, then handles the Medicare Advantage sequence: the initial five-day admission authorization, concurrent review against continued skilled need every five to seven days, and discharge PA. Submissions go to the plan portal or as a 278 electronic transaction, mapped to InterQual or MCG criteria. See AI for MDI Achieve.

SigmaCare

SigmaCare is a long-established skilled nursing clinical platform used at regional and national SNF operators, with integrations into common eMAR and revenue-cycle systems. Flexbone reads the SigmaCare chart (MDS, eMAR, and clinical notes) and assembles the Medicare Advantage authorization from it. The workflow follows the same admission-plus-concurrent-review pattern as other SNF EHRs: an initial skilled authorization, then reviews every five to seven days that submit updated clinical evidence to the plan, with peer-to-peer calls handled when a payer nurse asks for clinical detail.

AOD (Cantata Health)

AOD, now part of Cantata Health, serves skilled nursing and long-term care operations with combined billing and clinical modules. Flexbone reads census, clinical, and payer data from AOD and drives the Medicare Advantage authorization workflow from it: admission PA for the skilled stay, concurrent review every five to seven days against continued skilled need, and discharge authorization. Packets are mapped to InterQual or MCG criteria and submitted through the plan portal or as a 278 electronic transaction, with denials routed into an appeal.

Homecare Homebase (HCHB)

Homecare Homebase (HCHB) is a leading home health and hospice EHR at large national operators, built around a mobile-first clinician workflow with strong OASIS and billing integration. Flexbone integrates through the HCHB APIs, reading OASIS, the 485 plan of care, and physician face-to-face documentation. For Medicare Advantage and commercial home health that require prior authorization, Flexbone maps the record to plan criteria, submits it through the payer portal or a 278 transaction, and tracks reauthorization across the 30-day PDGM periods so visits are not delivered outside an active authorization.

ALayaCare

ALayaCare is a cloud-native home care and home health platform, strong in Canada and growing in the United States, with a modern API surface. Flexbone reads OASIS, care plans, and visit data through those APIs. For US home health lines that require prior authorization, including Medicare Advantage and commercial plans, Flexbone assembles the authorization from the clinical record, submits it through the payer portal or as a 278 electronic transaction, and reauthorizes across each payment period so scheduled visits stay covered.

TELUS Health

TELUS Health covers home care, home health, and pharmacy operations, with a substantial footprint in Canada and a growing US presence. Flexbone reads clinical, visit, and medication data from TELUS Health and, for US home health that requires prior authorization, builds the Medicare Advantage or commercial authorization from the record. Submissions go through the payer portal or as a 278 electronic transaction, mapped to the plan criteria, and Flexbone tracks reauthorization dates so care continues without a coverage gap between periods.

Integration and concurrent-review workflow

Post-acute PA integration has a unique shape: admission PA at the start, concurrent review every 5-7 days (SNF, LTACH, IRF) or at 30-day PDGM periods (home health), and discharge PA. Flexbone reads the daily or weekly clinical update from the EHR, maps it to MA plan criteria (InterQual or MCG), and submits the concurrent review packet. For SNF specifically, the typical pattern is: initial 5-day auth, then concurrent review against continued skilled need every 5-7 days. See post-acute PA for the full workflow.