Welcome to our Patient Eligibility Help Page!

Thank you for choosing our convenient Patient Eligibility Check System. We understand the importance of a seamless and efficient process when it comes to checking patient eligibility, and we’re here to assist you every step of the way.

This Help Page is specifically designed to provide clarification on the required data within the web form. Whether you have questions about specific fields, need guidance on entering information accurately, or seek additional information on the eligibility check process, you’re in the right place.


  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