LTC Eligibility Verification Services
270 / 271 checks, Medicaid look-back, MA plan eligibility, MOON notice. Our eligibility specialists run daily Medicare 270 / 271 transactions, validate Medicaid look-back status, verify MA plan benefits before admission, issue MOON notices on the right day, and calculate benefit-period day counts inside PointClickCare, MatrixCare, and SigmaCare.
0:55
0:48Wrong eligibility = wrong payer = unpaid stay.
SNF and LTC admissions can flip between Traditional Medicare, MA plan, Medicaid, dual eligible, and private pay within hours of a hospital discharge call. One missed 270 / 271 transaction or one late MOON notice and the facility absorbs the cost.
Benefit-period day count errors
Medicare Part A SNF benefits are limited to 100 days per benefit period. The benefit period resets only after 60 consecutive days with no inpatient or SNF Part A care. Mis-counted benefit days lead to claims rejecting at day 21, day 101, or the start of a new benefit period.
MA plan and dual eligibles confusion
A patient enrolled in an MA plan must have services pre-authorized by that plan, not Traditional Medicare. A dual eligible (Medicare + Medicaid) requires coordinated billing. Mis-identification at admission flips the payer mid-stay and triggers retroactive denials.
Missed MOON notice and look-back
The MOON (Medicare Outpatient Observation Notice) must be delivered within 36 hours of an outpatient observation lasting more than 24 hours. Missing it on the hospital side strips the 3-midnight rule and disqualifies the SNF stay. Medicaid look-back missed during application triggers later asset-disqualification.
Tell us about your agency.
Send us your situation and our team will scope the right setup, usually within one business day. No obligation.
What is a long-term care eligibility verification service ?
A long-term care eligibility verification service is a remote team that works inside your SNF or LTC admission workflow, runs daily Medicare 270 / 271 transactions against the CMS eligibility hub, checks MA plan enrollment and authorization rules, validates Medicaid status including the 5-year look-back where applicable, identifies dual eligibles before the first claim, tracks the MOON notice from the hospital side, and calculates the Medicare benefit-period day count including the 60-day reset rule. Not a generic eligibility clerk. An SNF-trained specialist who understands the 100-day benefit limit, the 3-midnight rule, and the difference between Part A inpatient and outpatient observation.
What your LTC eligibility pod handles, day to day
Pick the eligibility queues that hurt most. Your pod absorbs them. Your in-house team focuses on resident admissions, clinical assessment, and family communication.
270 / 271 daily transactions
Runs daily Medicare 270 eligibility inquiry transactions against the CMS hub and reads the 271 response for benefit-period, copay, and Part A day count.
MA plan benefits and auth
Confirms MA plan enrollment, network status, prior-auth requirements, and per-diem contract before admission. Flags out-of-network risk same day.
Medicaid look-back tracking
Validates Medicaid eligibility status including 5-year asset look-back where applicable. Flags pending applications and asset-transfer red flags.
Dual-eligible identification
Identifies dual eligibles (Medicare primary, Medicaid secondary) at admission. Confirms Medicaid as crossover payer. Coordinates patient liability.
MOON notice tracking
Verifies the MOON notice was delivered within 36 hours on the hospital side for any observation patient transferring to a SNF Part A admission.
Benefit-period day count
Calculates the Medicare Part A benefit-period day count including the 60-day reset rule. Tracks day 1 through day 100. Flags day 20 to 21 copay shifts.
COB and retro-eligibility
Runs coordination-of-benefits checks. Re-runs eligibility when Medicaid status changes mid-stay. Adjusts claim payer hierarchy retroactively.
Eligibility reports and KPIs
Daily admission eligibility report, weekly re-validation summary, MA plan denial rate by payer, and Medicaid pending conversion rate.
SNF-trained eligibility specialists, not generic call-center clerks
Most outsourcing companies offer general medical eligibility clerks. We do not. Our LTC eligibility specialists are tested on 270 / 271 transactions, the benefit-period 60-day rule, MOON notice timing, and MA plan authorization rules before placement.
LTC trained, not generic
Every specialist passes an assessment on 270 / 271 transactions, the Medicare Part A 100-day benefit limit, the 60-day benefit reset, MOON notice rules, Medicaid look-back, and at least one platform from PointClickCare, MatrixCare, or SigmaCare before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with 42 CFR 424 conditions of payment and 45 CFR 164.514 de-identification rules. Ask your current vendor for proof of all four.
2-Week Risk-Free Pilot
Industry offers no trial. We give you 14 days of live eligibility verification at the same rate. Cancel before day 14, owe nothing. No annual contracts after.
Staffingly vs DIY in-house vs generic offshore vs onshore BPO
The real cost math for a single full-time eligibility specialist role at a mid-size SNF or LTC operator.
From "let's talk" to live in 1 to 2 weeks
Six steps. Each one is documented. Nothing is mysterious.
Discovery call (15 min)
Tell us which eligibility pain is loudest. Day 21 copay surprises? MA plan denials? Missed MOON notices? Medicaid look-back issues? We map it on a shared call.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in PointClickCare, MatrixCare, SigmaCare, American HealthTech, plus your clearinghouse for 270 / 271.
Workflow shadow (2 to 3 days)
Your eligibility pod shadows your admissions team and business office. Hospital discharge call cadence captured. Payer scripts matched. Escalation rules locked.
Parallel pilot starts
Week 2 to 3. Your eligibility pod runs alongside your team. Daily 15-minute sync. You see every 270 ran, every 271 response logged, every MOON tracked.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most facilities keep going.
Full handoff, cadence locked
Daily admission eligibility report, weekly re-validation summary, MA plan denial rate, and Medicaid pending conversion rate KPIs in your inbox. Weekly review.
How Staffingly works, in practice
Inside the workA trained Staffingly specialist works inside your existing platform, with clear escalation back to your team.
One Flat Weekly Rate. No Surprises.
Dedicated senior care schedulers at a fixed weekly cost. Per scheduler FTE, per week. No contracts, no minimums, no hidden fees.
Want to compare against an in-house hire? Use the savings calculator.
Frequently asked questions
What are 270 / 271 transactions, and how often do you run them?
The 270 transaction is the HIPAA-standard eligibility inquiry submitted to a payer. The 271 is the response containing benefit-period status, Part A day count, copay tier, MA plan enrollment, and Medicaid coverage. We run 270 / 271 transactions at admission, weekly for any long-stay resident, and any time a payer change occurs. The standard is documented in CMS Implementation Guides for ASC X12 270/271 005010.
How does the Medicare Part A benefit period and 60-day reset work?
Medicare Part A SNF benefits are limited to 100 days per benefit period under 42 CFR 409.61. Days 1 to 20 are covered in full. Days 21 to 100 have a daily copay. A benefit period starts on the day of inpatient or SNF Part A admission and ends only after the beneficiary has been out of an inpatient or SNF Part A setting for 60 consecutive days. The new benefit period gives the beneficiary another 100 days.
What is the Medicaid look-back period, and what should I watch for?
Medicaid eligibility for long-term care includes a 60-month (5-year) look-back period during which any asset transfers below fair market value can trigger a transfer penalty. The penalty divides the transferred amount by the state's average monthly nursing home cost. We flag asset-transfer red flags during eligibility verification.
What is the MOON notice, and when is it required?
The Medicare Outpatient Observation Notice (MOON) is a CMS-required notice (CMS-10611) hospitals must deliver to any beneficiary who has been in outpatient observation for more than 24 hours. It must be delivered no later than 36 hours after observation began. Observation does not satisfy the 3-midnight rule required for SNF Part A coverage. We verify MOON delivery at SNF admission for observation patients.
How do you handle MA plan eligibility checks?
A patient enrolled in an MA plan has all services billed through that plan with its own prior-authorization, network, and per-diem contract rules. At admission we verify MA plan enrollment through the 270 / 271 plus the plan portal, confirm network and per-diem contract status, and request prior authorization with the expected length of stay.
How do you handle dual eligibles?
A dual eligible has both Medicare (primary) and Medicaid (secondary). We identify dual eligibles at admission by confirming Medicare through 270 / 271 and Medicaid through the state MMIS portal. We then set the payer hierarchy so Medicare bills first and Medicaid crosses over for the day 21 to day 100 copay. Some duals are in a D-SNP which changes payer routing entirely.
How does pricing work for LTC eligibility verification?
Per eligibility specialist FTE, per week. Per-skill pricing for admission verification, weekly re-validation, MA plan auth, and Medicaid look-back roles. No setup fees. $399 Standard, $349 Volume (3 or more), $299 Enterprise (10 or more). Add or remove specialists by the week. No annual contracts.
What is included in the 2-Week Risk-Free Pilot for LTC eligibility verification?
Two weeks of live eligibility verification running in parallel with your admissions team. Full reporting on admission-day eligibility verification rate, MA plan auth on-time percent, Medicaid pending conversion rate, and MOON notice verification rate. No setup fee. No penalty if you cancel before day 14.
President and CEO, Staffingly, Inc. 25+ years in IT consulting and healthcare BPO operations. One of the earliest US operators to set up an RPO/BPO delivery network in India. Leads AI-driven home care workflows that help agencies, home health providers, and multi-branch operators cut admin cost without compromising care.
