Medicare eligibility checks for your home health agency
Moative's AI agents run the Medicare eligibility check for your home health agency: 270/271 batches, payer calls and plan resolution before admission; our experts set the rules and take the exceptions.
Eligibility and benefit verification, in the order our study ranks them
- Medicare benefit position and payer-of-record determinationIn the top ten of 169 workflowsWorth it, ready now
- Medicare Advantage benefit detailIn the top 25 of 169 workflowsWorth it, ready now
- Medicaid eligibility, plan and program re-verification across the episodeIn the top half of 169 workflowsWorth it, ready now
- Identify patients requiring eligibility verificationIn the top half of 169 workflows
- Eligibility checkIn the top half of 169 workflows
- Coordination of benefits and secondary payer determinationIn the top half of 169 workflowsWorth it, ready now
- Hospice-related coverage checksIn the lower half of 169 workflows
- Verification calls for payers without electronic response and benefit-detail callsIn the lower half of 169 workflows
Your first workflow is one of these; our experts help you pick.
Talk about your eligibility work
Eligibility mistakes cost your agency real visits and money today
Coverage assumptions break quietly, and the cost surfaces months later as denials and unpaid visits.
Assumed traditional Medicare
Admissions guess what Medicare pays, learned wrong only at payment failure.
Payer calls on hold
Verification calls put staff on hold 20 to 40 minutes per call, so benefit detail never gets checked.
Medicaid lapses caught late
Plan switches surface at the denial, after months of visits already went unpaid.
The payer facts your agency runs on, settled before the visit
These workflows share one thing: our AI agents resolve each patient's coverage before visits go out, and our experts handle what they flag.
Payer of record settled before the patient is admitted
Today claims go out assuming traditional Medicare, and the assumption breaks when the claim denies for a Medicare Advantage enrollment. Our AI agents resolve plan of record and election status before admission.
- Payer of record set before admission
- No claim assumes traditional Medicare
- Hospice election confirmed before visits
Our AI agents place the verification calls
Today your staff wait through payer phone menus for every benefit-detail answer. Our AI agents dial the payer, work the phone tree, capture the benefit detail and write it to the episode; our experts handle the exceptions.
- Call answer written to the episode
- Staff never wait on payer hold
- Benefit detail, on record.
Medicare Advantage cost share known at admission
Medicare Advantage plans may impose home health cost sharing and authorization requirements. Our AI agents resolve plan benefit, visit limits and network status for each patient at admission.
- Patient share stated before visit one
- Authorization requirement known at admission
- Network status checked per patient
What the work asks of your agency, and who does what
Moative places our AI engineers inside your operation. We work backward from your goal, fix data, watch workflow, automate.
01What your agency brings
Access to your EMR, clearinghouse and payer portals, plus a lead from intake or billing who knows your payer mix. You keep all systems; nothing is replaced.
02What our experts do
Our experts sit with your team, watch the verification workflow as it runs, fix the data it depends on, and set the rules in your words.
03What our AI agents do
Our AI agents run batch 270/271 checks, place payer calls, re-verify Medicaid monthly, write every answer to episode, flag exceptions.
How custom AI inside your agency compares, for eligibility work
Your agency already has software, an EMR and maybe a billing company. Here is the honest line on each for eligibility and benefit verification, specifically.
Our experts and AI agents, inside your operation
Our engineers sit with your intake and billing teams, watch how eligibility actually runs, fix the data it depends on, and create AI agents for your payer mix, beside the EMR you keep.
- Fitted to the payers you actually bill
- Every rule written where your team sees it
- Runs beside the EMR, clearinghouse and portals
Billing and RCM software
Good at putting eligibility responses in one place. It usually checks what its portals support, and the rest stays manual phone work.*
Your EMR's billing module
Good at keeping eligibility answers next to the chart. It usually follows the standard payer path, so plan-specific rules ride on workarounds.*
An outsourced billing company
Good at taking the verification pile off your desk, usually per claim. Their people follow their playbook, on their hours.*
* Each category is described as it is commonly sold; vendors within a category vary. Terms, coverage and pricing vary by product and by contract.
Your agency keeps its systems, decisions and price
Do we have to replace our EMR or billing software?
No. Our AI agents run beside your EMR, clearinghouse and portals, reading and writing back. You keep every system.
How is this priced?
You pay a fee plus a part tied to results. The number moves only with the workflows our AI agents take over.
Who makes the calls when something is flagged?
Your staff. Our AI agents check and flag; your team makes the call on each flag. Our experts set the rules with your team, and your team can adjust them.
What does our agency need ready?
A lead from intake or billing who can walk us through your payer mix, and logins for the systems that hold eligibility today. Everything else stays as it is.
Admissions that start paid
Tell us which eligibility failure costs your agency the most. Our experts walk your numbers with you and pick the first workflow together.
Common questions
Will Medicare Advantage pay for home health care?
It depends on the plan. Medicare Advantage plans may impose home health cost sharing and authorization requirements on their members. Our AI agents resolve the cost share, visit limits and authorization requirement per admission.
What happens if your Medicaid lapses?
Visits billed during the lapse deny, usually months later. Our AI agents re-verify every active Medicaid patient monthly and flag a lapse before visits go unpaid.
How to check Medicare eligibility status?
Eligibility verification uses the HIPAA 270/271 electronic transactions. Our AI agents run the batch checks before admission and write the answer to the episode, using payer portals where a payer has no electronic response.
How much does Medicaid pay for hospice room and board?
Medicaid pays hospice room and board for patients residing in a nursing facility; the rate follows your state's Medicaid. Our AI agents resolve residency, the payment source and the rate at election.
How often must Medicaid eligibility be verified?
Medicaid eligibility is renewed once every 12 months; community engagement is verified at application and renewal, monthly only at state option. Our AI agents re-check active patients monthly anyway.
What does COB denial mean?
A COB denial means a different payer is primary for that patient. Our AI agents resolve the payer order at admission, so the claim goes to the right payer first.
What describes an eligibility requirement for home health?
Eligibility is checked at the initial assessment visit and again at the comprehensive assessment, updated at least in the last five days of every 60-day period. Our AI agents track who needs a check.
The full study, PDF · 636 KB
The winner is the dullest job in the building
Claim editing and cash posting beat every clever idea in the study, and they beat it every single time we re-ran the numbers.