A step-by-step guide for home health and hospice intake coordinators
In our last post, we talked about why Medicare Advantage doesn’t have to be a threat to your census — it’s an infrastructure problem, not a payer problem. This post is the infrastructure. If your intake team is still verifying MA benefits the same way they verify traditional Medicare, that’s where agencies lose time, lose revenue, and end up with denials that were preventable from day one.
Here’s the process to actually get it right.
Why MA Verification Isn’t the Same as Medicare Verification
Traditional Medicare is one set of rules, one payer, one process. “Medicare Advantage” isn’t a payer — it’s a category. Humana, UnitedHealthcare, Aetna, WellCare, and dozens of other carriers each run their own MA plans, and each one layers its own network rules, authorization requirements, and documentation standards on top of the Medicare framework it’s built on. The foundation is the same. The details on top are not. That’s where most verification mistakes happen — treating the foundation as the whole picture.
The Step-by-Step Process
Step 1 — Identify the actual carrier and plan, not just “Medicare Advantage”
Get the specific plan name off the insurance card, not just “MA.” Humana Gold Plus and Humana Honor are different plans with different rules, even under the same carrier. The plan name determines everything that follows.
Step 2 — Confirm network status before anything else
Is your agency in-network or out-of-network for this specific plan? This matters more with MA than with traditional Medicare, because out-of-network status can mean a flat denial, a reduced reimbursement rate, or — in some cases — reimbursement that still mirrors traditional Medicare rates, depending on the carrier’s out-of-network policy. Don’t assume. Confirm it for this plan, this patient, this referral.
Step 3 — Verify home health benefit activation specifically
Being enrolled in an MA plan doesn’t automatically mean home health benefits are active or structured the way you’d expect. Confirm the home health benefit is active under this specific plan and pull any visit limits or service-type restrictions tied to it.
Step 4 — Check prior authorization requirements
This is the step that trips up the most intake teams coming from a Traditional Medicare background. Traditional Medicare home health typically doesn’t require prior authorization. Most MA plans do — and the requirements vary by carrier and sometimes by service type within the same plan. Confirm authorization requirements before care starts, not after the first claim gets denied.
Step 5 — Document deductible and co-insurance status
Unlike Traditional Medicare, many MA plans carry patient cost-sharing for home health services. Confirm deductible status and any applicable co-insurance so there are no surprises for the patient or the agency later in the episode.
Step 6 — Put it all in one place before handing off to billing
A verification is only useful if the next person can act on it without calling the payer again. Structure your documentation the same way every time: carrier and plan name, network status, home health benefit status, authorization requirement and status, deductible and co-insurance. One format, every patient, every time.
The Most Common Mistake
The single biggest error we see: treating MA verification like a faster version of Medicare verification instead of a genuinely different process. The plans share a foundation, not a rulebook. Skipping straight to “they’re on Medicare Advantage, should be fine” is exactly how authorization requirements get missed and claims come back denied weeks later.
What This Looks Like at Scale
This six-step process works fine for a handful of referrals a week. It gets harder to hold consistently once volume grows — which is usually exactly when agencies can least afford the denials that come from skipping a step. That consistency problem is what we built Hayes RCM Intake to solve: benefits verification and prior authorization requests handled through one system, with every request documented the same structured way, every time. It’s currently in beta with a limited group of agencies, expanding more broadly September 11.
If your team is verifying MA benefits manually and wants a gut-check on the process, that’s a conversation we’re always happy to have — no pitch required.
Next in This Series
Getting verification right is half the equation. The other half is getting credentialed with the MA plans worth pursuing in the first place — that’s next.
