Insurance verification is the step that tells you whether the patient has coverage, what’s authorized, and what you need to do before you start care. Skipping it or doing it halfway leads to delayed starts and denials. Here’s a straightforward way to do it.
What to verify
Confirm the patient’s eligibility (active coverage, correct member ID and group), whether home health is a covered benefit, and whether you need prior authorization or a referral. For Medicare, that usually means checking eligibility and whether the patient is in a Medicare Advantage plan (which may have its own auth rules). For Medicaid and commercial plans, check the plan’s requirements,some want a referral number or an auth before the first visit.
When to do it
As soon as you have the referral and patient identifiers, run eligibility. Don’t wait until the day before SOC,our intake checklist that actually works keeps verification in the right order. If auth is required, start the process right away; some plans take days to respond. Build a habit: no SOC scheduled until eligibility is confirmed and any required auth is in hand or in progress.
Scripts and follow-up
When you call the payer, have the patient’s name, DOB, member ID, and the referring provider handy. Ask: Is the member eligible today? Is home health a covered benefit? Do we need prior authorization for this episode? What’s the process and turnaround time? Write down the rep’s name, date, and what they said. If they say “no auth needed,” note it. If they give you an auth number, put it in the chart and on the claim.
We have an insurance verification checklist you can download: the questions to ask, what to document, and when to do it so you’re not guessing. Use the button below to get it.