The patient's Financial tab answers two questions: who pays, and does the approval cover the visits ahead. Its left rail has Insurance & Eligibility, Authorizations, and Billing & Claims.
Record coverage
Open the patient → Financial tab. Each coverage is a card with the payer, a role badge (Primary, Secondary, Tertiary), a status badge (Active, Future, Inactive, Terminated), member ID, group, and dates.
Click Add Insurance. An episode must be selected before saving. Required: Payer Name, Member ID, Coverage Order.
If Relationship to Subscriber is not Self, enter the subscriber's name and date of birth.
Click Save Coverage.
Note: Medicare coverage cards cannot be edited by hand — their dates come from eligibility verification.
Run an eligibility check
In Eligibility, find the Medicare Eligibility Verification card (commercial payers have their own cards).
Click Run Eligibility Check → Automated Check (Inovalon), or Manual Verification if you verified by phone, portal, or fax.
Read the badge:
Badge | Meaning |
Verified | Active coverage, no blocking issues |
Manually Verified | Verified outside the system |
Action Required | A blocking issue needs attention before billing |
Needs Review | Something to review, e.g. Medicare Secondary Payer |
Stale | Older than 72 hours — run a fresh check |
Not Verified | No check on file |
Act on warnings
Warning | What to do |
Active Home Health Agency Detected | Contact the listed agency; the patient must be discharged there, or billing handles the overlap |
Hospice Election Active | Confirm hospice status with the patient and family — Medicare will not pay for home health during hospice |
Medicare Advantage Plan | The MA plan is the payer; contact the plan for billing and authorization requirements |
Medicare Secondary Payer | Another payer is primary; set the correct primary before billing |
To proceed despite a blocking issue: click Override and Continue, enter an Override Reason (at least 10 characters), check I have notified billing of this situation, and confirm. The warning is replaced by a record of who overrode it and when.
Track authorizations
Open Authorizations. If it is grayed out, assign coverage to the episode first. The payer must have Authorization Required turned on — if New Authorization is disabled, ask an administrator to update the payer.
Click New Authorization. Enter Payer, Authorization Number, Authorization Type, Start Date, End Date, and Status. Approved and Partially Approved require Approved Date; Denied requires Denial Reason.
Add a service line per discipline: Limit Type (visits, units, hours, days, dollars, date range), Unit Type, Frequency, Allowed Quantity.
The table tracks each authorization's PERIOD, UNITS (used/allowed per discipline, e.g. SN: 4/12), and STATUS. Use Edit to correct and Renew when the payer approves a new period.
To see gaps across all patients, open Reports → Insufficient Authorizations. Rows appear as Insufficient (3 or fewer units left), Expired, Pending, or Not Obtained.
If something goes wrong
Eligibility did not run on a referral. Run it from the referral's Financial tab, or from the patient chart after admission. Automated checks need a payer that supports them; otherwise record a Manual Verification.
The check is Stale. Results older than 72 hours are not trusted for billing. Run a fresh check.