Manual eligibility checks are slow, error-prone, and do not scale. A 200-patient agency checking monthly burns 4 to 8 hours per billing cycle — and still misses mid-cycle coverage changes. ClientCare automates the entire process: weekly Medicaid checks, monthly Medicare checks, and instant alerts when anything changes.
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4-8 hrs
Saved per billing cycle vs. manual checks
Weekly
Medicaid checks (industry does monthly)
Any EMR
Works via CSV upload — no integrations needed
A 200-patient agency checking eligibility manually burns 4 to 8 hours per billing cycle. Staff log into payer portals one patient at a time, copy results into spreadsheets, and still miss changes that happen between checks.
The industry standard is a monthly batch eligibility check. But Medicaid coverage can change any day — redetermination deadlines, plan switches, and enrollment drops happen on their own schedule. A monthly check leaves 3-week blind spots.
Your billing coordinator did not get hired to log into Availity, Medicaid portals, and Medicare systems all day. Manual eligibility verification is the most automatable task in your revenue cycle, yet most agencies still do it by hand.
Pull your patient roster from WellSky, Axxess, AxisCare, Homecare Homebase, or any other system. Export as CSV — no special formatting needed. ClientCare's AI maps your columns automatically.
Drag and drop your CSV into ClientCare. The system assigns each patient a check interval based on payer type: daily for new intakes, weekly for Medicaid, monthly for Medicare. No configuration required.
ClientCare monitors continuously and notifies you the moment eligibility changes. You see the patient, the payer, what changed, and what to do — before your billing team submits a claim that will deny.
Direct EDI integration, risk-based scheduling, and multi-payer support — not a portal scraper or a monthly batch job.
ClientCare sends standard HIPAA 270 eligibility inquiries directly to payers and parses 271 responses automatically. The same electronic data interchange your clearinghouse uses — without the clearinghouse middleman or monthly fees.
Not all patients carry the same eligibility risk. Medicaid patients are checked weekly because redetermination churn is high. Medicare Advantage monthly. New intakes get daily checks for the first 7 days. The system focuses effort where risk is highest.
When a patient's coverage status changes — active to inactive, plan switch, benefit modification — you receive an instant alert with the patient name, payer, change type, and recommended action. No more finding out from a denial.
Export your patient roster from WellSky, Axxess, AxisCare, Homecare Homebase, or any other system as a CSV. Upload it to ClientCare. AI maps your columns automatically — no special formatting, no integrations to build.
Any agency that verifies patient eligibility before or during care delivery. The more patients on your census, the more time you save.
The primary use case. Replace hours of manual portal lookups with automated weekly and monthly checks.
Verify Medicare hospice benefit eligibility continuously, not just at admission.
Monitor Medicaid eligibility for long-stay residents who cycle through redetermination windows.
High Medicaid populations with frequent coverage disruptions. Automated checks prevent billing gaps.
Verify coverage for every patient your contracted staff serves — across multiple client agencies.
Waiver program eligibility monitoring for residents receiving Medicaid-funded services.
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