Eligibility Check-Help

Patient Eligibility Assistance

Thank you for utilizing our Patient Eligibility Check System. We recognize the importance of a smooth, efficient process for verifying patient eligibility, and we are committed to providing you with the support you need.

This page is designed to offer clear guidance on completing the web form accurately. Whether you require clarification on specific fields, assistance with data entry, or additional information about the eligibility check process, we are here to help ensure your experience is both seamless and effective.

  1. Request Date:
    • Today’s date: REQUIRED Format is MM/DD/YYYY.
  2. Request Type:
    • Options:
      • New Patient: Select this if the individual is a new patient.
      • Previous Patient: Select this if the individual has been a patient before.
      • Current Patient-Re-Check: Select this for re-checks on current patients.
  3. Agency NPI:
    • National Provider Identifier (NPI) for the agency.
  4. Email:
    • Provide your email address for communication and notifications.
  5. Last Name, First Name:
    • Enter the patient’s last name and first name.
  6. DOB (Date of Birth):
    • Patient’s DOB: REQUIRED Format is MM/DD/YYYY.
  7. SSN (Social Security Number):
    • Enter the patient’s social security number for identification purposes.
  8. Medicare Number:
    • Include the patient’s Medicare number if applicable.
  9. Other Insurance Co:
    • If the patient has a Medicare Advantage Plan, or other types of Insurance, list the name of that Insurance here.
  10. Other Insurance ID:
    • The Member ID (Policy Number) of the Other Insurance Co from field 9.
  11. Hospice Patient?
    • Is the patient currently on Hospice or transferring from Hospice?
  12. Referral Source:
    • MD Office: Referral from a Doctor’s Office or Clinic
    • Hospital: Referral from a Hospital
    • SNF (Skilled Nursing Facility)
  13. County Services Rendered (Optional):
    • We can provide you with an estimated episodic reimbursement amount based on 2024 Billable HIPPS Codes.
    • We must have the County the services are rendered; not the city or town.
  14. 1st 30 Days HIPPS (Optional):
    • Using your PDGM calculator in your EMR, provide us with the 1st Billing Period’s Estimated Billable HIPPS Code.
  15. 2nd 30 Days HIPPS (Optional):
    • Using your PDGM calculator in your EMR, provide us with the 2nd Billing Period’s Estimated Billable HIPPS Code.
  16. Upload A File (Optional):
    • Upload the Referral
Eligibility Check page

If you require further assistance or have any additional questions, our support team is readily available to help.

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