Home Health Care Claims Process

Step 1:  Claim Initiated & Information Collected
When you initiate a claim, it is assigned to a claim examiner and a nurse case manager. They will collect information from your physician, and a nurse from an independent company may also visit you to gather additional information.

Step 2:  Eligibility Review & Determination
The claim examiner and case manager will review all of the information received and evaluate your health condition, providers, and the services you are receiving to make sure they are covered under the terms of your policy. The case manager will call you to discuss your plan of care.

Step 3:  Notification
You will be informed by letter of the decision regarding the claim.

Step 4:  Processing of Covered Charges Incurred
If the claim examiner finds that all terms and conditions of the policy are met and all requested information has been received, the billing forms will be processed in accordance with the terms of the policy. Please remember to submit bills on a regular basis to avoid processing delays.