SNF Medicare Benefits Verification Services
We verify Medicare benefits for every SNF admit before the resident arrives. 270/271 electronic eligibility transactions, 3-day qualifying hospital stay confirmation, Part A benefit period day counts (1-20 vs 21-100), MOON notice delivery, Medicare Advantage prior authorization, and secondary insurance. Logged inside PointClickCare, MatrixCare, Net Health, and American HealthTech. 800+ providers trust us. Pilot in 2 weeks.
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0:48The intake pain points we eliminate
Three pressures hit the business office on every Medicare admit. Missed 3-day qualifying stays kill Part A coverage. Day-count errors at the 20 and 100 mark create write-offs. MA plan prior auth gaps stop the admit on day one.
Missed 3-day qualifying hospital stay
Medicare Part A SNF coverage requires a 3-day medically necessary inpatient hospital stay. Observation status does not count. When the stay is misread, the admit is non-covered and the resident or family gets a surprise bill.
Day-count errors at the 20 and 100 mark
Days 1-20 are at 100 percent. Days 21-100 carry the daily coinsurance. After day 100, Medicare Part A ends. Miss either threshold and the bill is wrong. Cash ages.
Medicare Advantage prior auth gaps
MA plans run their own SNF prior authorization, day counts, and approval windows. Each plan is different. When prior auth is not on file day one, the admit stalls or the claim denies.
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 SNF Medicare benefits verification service ?
A SNF Medicare benefits verification service is a remote business-office function that runs Medicare eligibility checks for every SNF admit before the resident arrives. The coordinator runs the 270/271 electronic eligibility transaction, confirms the 3-day qualifying hospital stay, tracks Part A benefit period day counts, delivers the MOON notice when required, and confirms Medicare Advantage prior authorization on day one.
What your Medicare benefits coordinator actually handles, day to day
Pick the verification work that hurts most. Your coordinator absorbs it. Your business office focuses on collections, denials, and month-end close.
270/271 eligibility transactions
Runs the 270 eligibility inquiry through your clearinghouse or HETS. Reads the 271 response. Documents Part A eligibility, benefit period days, and plan information in the admission packet.
3-day qualifying hospital stay confirmation
Confirms the medically necessary 3-day inpatient hospital stay required for Part A SNF coverage. Observation days do not count. Hospital records reviewed, dates documented.
Benefit period day-count tracking
Tracks days 1-20 (full coverage) and 21-100 (daily coinsurance). Flags the day 100 endpoint. Watches the 60-day wellness period reset. Updates the chart daily.
MOON notice delivery
Delivers the Medicare Outpatient Observation Notice when the prior hospital stay was observation rather than inpatient. Documented and signed within the required window.
Medicare Advantage prior auth
Confirms MA plan prior authorization for the SNF stay before admit. Day count, approval period, and re-auth requirements logged. Each plan's rules captured per resident.
Secondary insurance verification
Verifies the secondary payer. Medicare supplement plans, retiree coverage, or Medicaid as secondary. Coordination of benefits documented in the chart.
Retroactive coverage handling
When Medicare or MA coverage is established retroactively, the coordinator re-bills, adjusts day counts, and refunds liability collected in error. Cash applied correctly.
Verification KPI reporting
Weekly KPI report covering verification turnaround, qualifying-stay confirmation rate, MA prior auth completion before admit, and any open verification queries.
Intake-trained coordinators, not generic VAs
Most outsourced vendors check eligibility once and call it done. Our Medicare benefits coordinators verify eligibility, qualifying stay, day counts, MA prior auth, and secondary insurance on every admit and update the file daily until day 100 or discharge.
Medicare-trained, not generic
Every coordinator passes an assessment on the 270/271 transaction set, the 3-day qualifying stay rule, Part A benefit periods, the 60-day wellness reset, the MOON notice requirement, and Medicare Advantage prior authorization rules before placement.
Per-plan MA prior auth playbook
We maintain a working file for each major MA plan: UnitedHealthcare, Humana, Aetna, Anthem, Centene, Molina, Kaiser, regional Blues. Day counts, approval windows, re-auth timelines, and escalation contacts tracked.
Daily day-count audit
Days 1-20, 21-100, and the day 100 endpoint are audited daily. The 60-day wellness reset is tracked. No more surprise non-covered days at month-end.
Staffingly vs DIY in-house vs generic VA vs onshore BPO
The real cost math for a single full-time intake coordinator role at a mid-size SNF, ALF, or home care 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 where verification breaks. Missed qualifying stays? Day-count errors? MA plan gaps? We map it on a shared call. No prep needed from you.
BAA + platform access
Business associate agreement signed. Role-based access provisioned in PointClickCare, MatrixCare, Net Health, or American HealthTech. Clearinghouse, HETS, and MA portal credentials configured.
Workflow shadow (2 to 3 days)
Your benefits coordinator shadows your on-site business office. 270/271 workflow captured. MA plan playbooks logged. MOON notice template tailored.
Parallel pilot starts
Week 2 to 3. Your coordinator runs alongside your team. Daily 15-minute sync. You see every verification, every qualifying stay confirmed, every MA prior auth on file.
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
Verification turnaround, qualifying-stay confirmation rate, and MA prior auth completion KPIs in your inbox weekly. Monthly QA audit of the verification file.
How your intake coordinator's day actually looks
A real shift, hour by hour. Times shown in your local time. We rotate coverage so your admissions phone 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
What are 270 and 271 transactions?
The 270 is the HIPAA-standard electronic eligibility inquiry sent to the payer. The 271 is the payer's response, returning eligibility status, plan information, and benefit details. We run 270/271 through your clearinghouse or HETS for every Medicare and Medicare Advantage admit before the resident arrives.
How does the 3-day qualifying hospital stay rule work?
Medicare Part A SNF coverage requires a 3-day medically necessary inpatient hospital stay within the 30 days before SNF admission. Observation status does not count. We pull the hospital record, confirm inpatient status with dates, and document the qualifying stay in the admission packet before bed assignment.
What are the SNF Part A day-count rules?
Under the current Part A benefit period: days 1-20 are covered at 100 percent. Days 21-100 carry a daily coinsurance. After day 100, Medicare Part A ends for the benefit period. A new benefit period starts after 60 consecutive days without inpatient hospital or SNF care. We track each threshold daily.
When is the MOON notice required?
The Medicare Outpatient Observation Notice is required when a Medicare beneficiary receives observation services as an outpatient for more than 24 hours. For SNF admits, the relevant question is whether the prior hospital stay was inpatient (qualifying) or observation (not qualifying). When the stay was observation, we deliver the MOON notice within the required window and document the signature.
How is Medicare Advantage benefit verification different from traditional Medicare?
MA plans run their own SNF prior authorization, day-count rules, and approval windows. Each plan is different. Some MA plans waive the 3-day qualifying stay. Some require concurrent review at day 5 or day 7. We maintain a per-plan playbook and confirm prior authorization on file before admit. Day counts and re-auth dates are tracked per resident.
How is retroactive Medicare or MA coverage handled?
When Medicare or MA coverage is established retroactively, the coordinator re-bills the stay, adjusts the day counts, and refunds any liability collected from the resident or family in error. The chart and the billing system are reconciled so cash applies correctly.
What does Medicare benefits verification cost?
Per FTE per week pricing: $399 single-building, $349 at 3+ FTEs, $299 at 10+ FTEs. No setup fees. Flat weekly billing. Same rate during the 2-Week Risk-Free Pilot.
How does the 2-Week Risk-Free Pilot work?
Two weeks of live Medicare benefits verification at the same per-FTE weekly rate. Cancel before day 14 and you owe nothing. No annual contracts after. Most operators decide to keep going within the first 10 days because the qualifying-stay error rate drops and MA prior auth shows up on day one.
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.
