Questions often arise regarding eligibility, scheduling timelines, insurance participation, and service coordination. Reviewing common inquiries can clarify procedures and expectations before services begin. Explore the information provided to better understand how home care arrangements are structured and initiated.
What are the steps to become a Private Pay, Medicaid/Medicaid HMO, or CAP Client?
Steps to Becoming a Private Pay, Medicaid/Medicaid HMO, and/or Community Alternative Program (CAP) Client
Private Pay:
- Contact Prosperity Homecare regarding the client’s need for the potential service.
- An agency nurse will assess the client’s needs for the service. The care plan will be created and reviewed with the client.
- Admission and contract will be initiated for personal care services.
Medicaid or Medicaid HMO Client:
- If the client has never received personal care services, a referral form must be taken to their primary care provider for request of services using Form DHB-3051.
- The primary care provider must fax the completed DHB-3051 form to Acentra Health (NCI FTS) at 833-521-2626.
- Acentra Health’s managed care nurse will contact the client to schedule a nurse assessment and agency selection.
- Once approved for services by Acentra Health, the client will be contacted regarding approved hours of service. When Prosperity Homecare receives confirmation of assessment and has been selected as the agency of choice, Prosperity’s nurse will contact the client to schedule an initial assessment to formulate the plan of care.
Community Alternative Program (CAP):
- The client will need to contact the CAP Services Department for CAP approval.
- Once approved, the case manager from CAP will send an authorization for services to Prosperity Homecare along with the approved amount of CAP hours.
- The agency nurse will contact the client to schedule an initial assessment to formulate the plan of care.
How long does it take for services to begin?
What insurances are accepted?
Understanding coverage details helps coordinate home care services without delays or billing confusion. Eligibility, authorizations, and participation requirements vary depending on the plan and service needs.
- NC Medicaid State Plan
- Medicaid HMO plans (Alliance, AmeriHealth, Carolina Complete, Healthy Blue, Wellcare, United Healthcare)
- Veteran Assistance
- Worker’s Compensation
Contact us to review insurance verification and coverage coordination for your situation.
Schedule Your Care Planning Discussion
Reach out to discuss scheduling, care coordination, and daily assistance planning. Our team will review how in-home services are organized and implemented based on identified household needs.
