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This guide takes a referral from first contact through to a member receiving billable care. It crosses four modules. Doing the steps in order matters, because each one depends on the last.

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Before you start

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The full path

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Step 1 — Log the referral

1

Open Intake

Go to Clinical → Intake. See Intake.
2

Record the referral

Name, Source, and Referred date. Log it the day it arrives — referral sources notice response times.
3

Set the stage

The kanban board above the tabs shows where every referral sits.

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Step 2 — Verify eligibility

1

Check payer eligibility

Confirm before investing in assessment. Set Eligibility on the referral.
2

Confirm the Medicaid ID and date of birth

These must match the payer’s record exactly. Mismatches here cause claim denials months later.
3

Close the referral if not eligible

Use NON_ADMIT or DISREGARDED_REFERRAL rather than leaving it open.
Verifying eligibility is not the same as holding an authorization. Eligibility means the person is covered; an authorization means the payer has approved specific services. You need both.

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Step 3 — Complete the assessment

1

Carry out the clinical assessment

Set Assessment on the referral when done.
2

Record risk assessments

Fall risk and readmission risk, with a Next Due date. See Assessments.

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Step 4 — Create the member record

1

Convert the referral

Create the member record. The referral’s Member column links to it.
2

Enter demographics and Medicaid ID

Carefully — this is what claims are matched on. See Members.
3

Verify the address

A wrong address causes systematic EVV geofence failures later. See Time & Attendance.
4

Link the care network

Attending physician, case manager, and payer. See Care network.
Get the address right now. An incorrect member address produces a geofence failure on every single visit, and each one has to be individually corrected before it can be billed.

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Step 5 — Record the authorization

1

Enter the authorization

Auth #, Service Code, Begin, End, Units, and Cap Units, copied exactly from the payer’s approval. See Authorizations.
2

Set the status to active

Scheduling checks this before allowing billable visits.
3

Confirm service items

Record what the member actually receives.

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Step 6 — Complete the member file

1

Provide and acknowledge member rights

Set Provided, Acknowledged, Privacy Notice, and DNR Status. See Member safeguards.
2

Confirm chart inventory

Set PAS Consent and Inventory Done. See Member records.
3

Generate required Texas HHS forms

Then track them through to Signed.
4

Confirm the physician order

Dated on or before the service start date. See Clinical logs.
A physician order dated after services begin does not authorize them retrospectively. Confirm the order is in place before the first visit.

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Step 7 — Build the care plan and schedule

1

Create the care plan

Assign the physician, set Next Review, and move it from DRAFT to ACTIVE. See Care Plans.
2

Build the recurring schedule

Link it to the authorization. Set Effective To to match the authorization end date. See Scheduling.
3

Assign a credentialed attendant

Confirm their credentials and background checks are current. See Credentials and checks.
4

Set the member status to ACTIVE

The member is now in service.

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Admission checklist

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What goes wrong most often

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Next

EVV to paid claim

What happens after the first visit.

Credentialing a caregiver

Getting an attendant ready to assign.