LTC Eligibility Verification (Intake)
We run eligibility checks at the moment of intake for every LTC admission. 270/271 EDI transactions for Medicare Part A, Medicaid MMIS lookups, Medicare Advantage plan checks, dual eligibility, benefit-period accumulator math, and OON authorization holds. 800+ providers trust us. Pilot in 2 weeks.
0:55
0:48Your intake team is guessing at benefits and eligibility .
Three eligibility failures quietly cost LTC operators thousands per week. Each one starts at intake and ends in the business office with a denied claim, a Medicaid pending case, or a write-off that nobody can recover.
270/271 transactions skipped or stale
If your intake coordinator does not run a 270 eligibility inquiry on the day of admission, you are billing on yesterday's coverage. A Part A benefit period that exhausted last week shows up as a denied claim three weeks later.
Dual eligibility missed at intake
Residents who are dual eligible for Medicare and Medicaid need both checks. Missing the secondary Medicaid coverage at intake means the building eats coinsurance and deductibles that should have been paid by the state.
OON authorization holds left undocumented
Out-of-network Medicare Advantage admissions need a documented authorization hold or single-case agreement before bed assignment. Without it, the MA plan denies the claim and the resident becomes a self-pay write-off.
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 LTC eligibility verification at intake ?
LTC eligibility verification at intake is a remote eligibility specialist who runs every payer check the moment a referral hits your intake desk. Not a generic benefits VA. Not a one-time call to the payer. A trained eligibility coordinator who runs 270/271 EDI transactions, checks Medicaid MMIS portals, confirms Medicare Advantage plan participation, and documents dual eligibility before the bed decision is made.
What your LTC eligibility specialist actually handles, day to day
Pick the eligibility queues that hurt most. Your coordinator absorbs them. Your on-site admissions director focuses on tours, family meetings, and referral relationships.
270/271 EDI transactions
Runs HIPAA 270 eligibility inquiries through Availity, Change Healthcare, Waystar, or your clearinghouse. Reads the 271 response, logs Part A days remaining, deductible status, and benefit-period dates.
Medicaid MMIS lookups
Checks state Medicaid management information systems for enrollment, plan assignment, lookback status, and pending application data. Documents results in the chart with timestamps.
Medicare Advantage plan checks
Confirms MA plan participation, in-network status, prior authorization requirements, and any utilization management vendor like NaviHealth or myNexus before the bed decision.
Dual eligibility verification
Identifies QMB, SLMB, and full dual eligibility status. Coordinates secondary Medicaid coverage so the building captures coinsurance, deductibles, and Part B liability that should not become write-offs.
Benefit-period accumulator
Tracks the 100 Part A SNF days and the 60-day wellness period. Calculates remaining covered days, prior-stay carryover, and projected coinsurance start date before admission.
OON authorization holds
Documents out-of-network MA admissions with authorization holds or single-case agreements. Tracks expiration dates and escalates to the business office before any clinical service starts.
Coverage documentation
Stores every eligibility response, payer call notes, and reference numbers in the chart. Provides a clean audit trail for billing, the business office, and any future appeal.
Same-day intake SLA
Returns full eligibility results within 4 business hours of referral acceptance for skilled admits. 24-hour turnaround on Medicaid pending cases. Faster decisions, fewer referral losses.
Eligibility-trained coordinators, not generic VAs
Most outsourcing companies offer call-center agents and call them "benefits verifiers." We do not. Our eligibility specialists are 270/271-tested, MMIS portal-trained, and EMR-certified before they ever touch a live admit packet for your building.
Eligibility-trained, not generic
Every coordinator passes an assessment on 270/271 EDI transactions, Medicare Part A benefit periods, managed Medicaid plans, dual eligibility rules, and at least one major EMR from PointClickCare, MatrixCare, or HHAeXchange before placement.
Stacked compliance posture
HIPAA + SOC 2 Type II + ISO 27001 + HITRUST. Plus alignment with the 45 CFR 164.514 de-identification standard for analytics and 42 CFR 483.10 resident rights. Ask your current vendor for proof of all four. We will wait.
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 VA vs onshore BPO
The real cost math for a single full-time LTC eligibility verification 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. Stale 270 transactions? Missed dual eligibility? OON denials? We map it on a shared call. No prep needed from you.
BAA + clearinghouse access
Business associate agreement signed. Role-based access provisioned in PointClickCare or MatrixCare. Clearinghouse credentials set up for Availity, Change Healthcare, or Waystar.
Workflow shadow (2 to 3 days)
Your coordinator shadows your on-site intake team in NJ, NY, TX, or FL. Payer plays captured. Escalation rules locked. SLA windows set per referral type.
Parallel pilot starts
Week 2 to 3. Your eligibility coordinator runs alongside your team. Daily 15-minute sync. You see every 270 response, every MMIS check, every MA plan confirmation.
Decision point (end of week 2)
Pilot results reviewed. Go or no-go. No penalty if you cancel. Most operators keep going.
Full handoff, cadence locked
Eligibility SLA, denial rate, and Medicaid pending aging KPIs in your inbox. Weekly review with your account lead. Monthly QA audit. Expansion paths discussed.
How your eligibility coordinator's day actually looks
A real shift, hour by hour. Times shown in your local time. We rotate coverage so your eligibility queue is never dark during business hours.
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
How do you run 270/271 EDI transactions at intake?
We run HIPAA 270 eligibility inquiries through your clearinghouse of record, typically Availity, Change Healthcare, or Waystar. The 271 response is read for Part A days remaining, deductible status, benefit-period start and end, prior SNF stays, and any plan-level restrictions. We post the response, payer reference numbers, and a coordinator note in the chart so billing has a clean day-one record.
How is dual eligibility identified and documented?
Dual eligibility checks combine a 270 inquiry for Medicare with a state Medicaid MMIS lookup. We capture QMB, SLMB, and full dual status, then post the secondary Medicaid coverage to the chart. For dual-eligible residents the building captures coinsurance, deductibles, and Part B liability that would otherwise become write-offs.
How are Medicare Advantage plan checks handled?
For every Medicare Advantage referral we confirm in-network status, prior authorization requirements, and any utilization management vendor involvement such as NaviHealth or myNexus. The result is logged in PointClickCare or MatrixCare and surfaced to the on-site admissions director before the bed decision so MA denials do not arrive three weeks later.
How do you track the benefit-period accumulator?
The 100 Part A SNF days and the 60-day wellness period reset rules are coded into our intake checklist. We log days used to date, prior-stay carryover, projected coinsurance start date, and any 60-day wellness exposure. The business office gets a weekly benefit-period aging report so no resident hits day 21 without a coinsurance plan in place.
How are OON authorization holds managed?
Out-of-network Medicare Advantage admissions get a documented authorization hold or single-case agreement before bed assignment. We file the request with the MA plan, capture the auth number and expiration, and escalate to the business office before any clinical service starts. No SCA in writing means no admit.
What is the same-day intake SLA?
Standard SLA is 4 business hours from referral acceptance to full eligibility return for skilled admits. Medicaid pending and complex dual-eligible cases run on a 24-hour SLA. Coordinators rotate coverage to keep the eligibility queue live during your local business hours.
How is the eligibility role priced?
$399 per FTE per week at single-building rate. $349 at 3+ FTEs (volume). $299 at 10+ FTEs (enterprise). No setup fees. Flat weekly billing. Add or remove FTEs by the week. 2-Week Risk-Free Pilot at the same rate.
How does the 2-Week Risk-Free Pilot work?
You sign a short pilot order at the per-FTE weekly rate. The eligibility coordinator runs live work for 14 calendar days. At the end of week 2, you make a go or no-go call. Cancel before day 14, owe nothing. No annual contracts after. Replacement coordinator at no charge if the fit is wrong.
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.
