> ## Documentation Index
> Fetch the complete documentation index at: https://docs.officeridge.com/llms.txt
> Use this file to discover all available pages before exploring further.

# New member admission

> Take a referral from first contact through eligibility, assessment, and admission to active service.

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.

## Before you start

| You need                     | Why                                                                                  |
| ---------------------------- | ------------------------------------------------------------------------------------ |
| Access to Intake and Members | The Client Coordinator, Clinical Manager, Location Admin, or Organization Admin role |
| An active payer record       | Authorizations attach to a payer                                                     |
| An active payer contract     | A lapsed contract stops payment even with a valid authorization                      |

## The full path

```mermaid theme={null}
graph LR
    A[Referral<br/>logged] --> B[Eligibility<br/>verified]
    B --> C[Assessment<br/>completed]
    C --> D[Member record<br/>created]
    D --> E[Authorization<br/>recorded]
    E --> F[Care plan<br/>active]
    F --> G[Schedule<br/>built]
    G --> H[Billable<br/>visits]
```

## Step 1 — Log the referral

<Steps>
  <Step title="Open Intake">
    Go to **Clinical → Intake**. See [Intake](/intake).
  </Step>

  <Step title="Record the referral">
    Name, **Source**, and **Referred** date. Log it the day it arrives — referral sources notice
    response times.
  </Step>

  <Step title="Set the stage">
    The kanban board above the tabs shows where every referral sits.
  </Step>
</Steps>

## Step 2 — Verify eligibility

<Steps>
  <Step title="Check payer eligibility">
    Confirm before investing in assessment. Set **Eligibility** on the referral.
  </Step>

  <Step title="Confirm the Medicaid ID and date of birth">
    These must match the payer's record exactly. Mismatches here cause claim denials months later.
  </Step>

  <Step title="Close the referral if not eligible">
    Use `NON_ADMIT` or `DISREGARDED_REFERRAL` rather than leaving it open.
  </Step>
</Steps>

<Warning>
  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.
</Warning>

## Step 3 — Complete the assessment

<Steps>
  <Step title="Carry out the clinical assessment">
    Set **Assessment** on the referral when done.
  </Step>

  <Step title="Record risk assessments">
    Fall risk and readmission risk, with a **Next Due** date. See
    [Assessments](/members/assessments).
  </Step>
</Steps>

## Step 4 — Create the member record

<Steps>
  <Step title="Convert the referral">
    Create the member record. The referral's **Member** column links to it.
  </Step>

  <Step title="Enter demographics and Medicaid ID">
    Carefully — this is what claims are matched on. See [Members](/members).
  </Step>

  <Step title="Verify the address">
    A wrong address causes systematic EVV geofence failures later. See
    [Time & Attendance](/attendance).
  </Step>

  <Step title="Link the care network">
    Attending physician, case manager, and payer. See [Care network](/members/care-network).
  </Step>
</Steps>

<Warning>
  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.
</Warning>

## Step 5 — Record the authorization

<Steps>
  <Step title="Enter the authorization">
    **Auth #**, **Service Code**, **Begin**, **End**, **Units**, and **Cap Units**, copied exactly
    from the payer's approval. See [Authorizations](/members/authorizations).
  </Step>

  <Step title="Set the status to active">
    Scheduling checks this before allowing billable visits.
  </Step>

  <Step title="Confirm service items">
    Record what the member actually receives.
  </Step>
</Steps>

## Step 6 — Complete the member file

<Steps>
  <Step title="Provide and acknowledge member rights">
    Set **Provided**, **Acknowledged**, **Privacy Notice**, and **DNR Status**. See
    [Member safeguards](/compliance/member-safeguards).
  </Step>

  <Step title="Confirm chart inventory">
    Set **PAS Consent** and **Inventory Done**. See [Member records](/members/records).
  </Step>

  <Step title="Generate required Texas HHS forms">
    Then track them through to **Signed**.
  </Step>

  <Step title="Confirm the physician order">
    Dated on or before the service start date. See [Clinical logs](/operations/clinical-logs).
  </Step>
</Steps>

<Warning>
  A physician order dated after services begin does not authorize them retrospectively. Confirm the
  order is in place before the first visit.
</Warning>

## Step 7 — Build the care plan and schedule

<Steps>
  <Step title="Create the care plan">
    Assign the physician, set **Next Review**, and move it from `DRAFT` to `ACTIVE`. See
    [Care Plans](/care-plans).
  </Step>

  <Step title="Build the recurring schedule">
    Link it to the authorization. Set **Effective To** to match the authorization end date. See
    [Scheduling](/scheduling).
  </Step>

  <Step title="Assign a credentialed attendant">
    Confirm their credentials and background checks are current. See
    [Credentials and checks](/employees/credentials-and-checks).
  </Step>

  <Step title="Set the member status to ACTIVE">
    The member is now in service.
  </Step>
</Steps>

## Admission checklist

| Done | Item                                         | Where                                                       |
| :--: | -------------------------------------------- | ----------------------------------------------------------- |
|   ☐  | Referral logged with source and date         | [Intake](/intake)                                           |
|   ☐  | Eligibility verified                         | [Intake](/intake)                                           |
|   ☐  | Assessment and risk assessments complete     | [Assessments](/members/assessments)                         |
|   ☐  | Member record created, address verified      | [Members](/members)                                         |
|   ☐  | Physician, case manager, payer linked        | [Care network](/members/care-network)                       |
|   ☐  | Authorization active with units              | [Authorizations](/members/authorizations)                   |
|   ☐  | Member rights provided and acknowledged      | [Member safeguards](/compliance/member-safeguards)          |
|   ☐  | Chart inventory and PAS consent recorded     | [Member records](/members/records)                          |
|   ☐  | Physician order in place and dated correctly | [Clinical logs](/operations/clinical-logs)                  |
|   ☐  | Care plan active with next review date       | [Care Plans](/care-plans)                                   |
|   ☐  | Recurring schedule built and bounded         | [Scheduling](/scheduling)                                   |
|   ☐  | Attendant credentialed                       | [Credentials and checks](/employees/credentials-and-checks) |
|   ☐  | Member status set to ACTIVE                  | [Members](/members)                                         |

## What goes wrong most often

| Problem                             | Cause                                             | Prevention                       |
| ----------------------------------- | ------------------------------------------------- | -------------------------------- |
| Every visit fails geofence          | Wrong member address                              | Verify the address at admission  |
| Claims deny on identity             | Medicaid ID or DOB mismatch                       | Check against the payer's record |
| Visits generate but do not bill     | No active authorization, or wrong service code    | Confirm before scheduling        |
| Services unbillable                 | Physician order missing or dated late             | Confirm before the first visit   |
| Schedule outlives the authorization | **Effective To** later than authorization **End** | Match the dates                  |

## Next

<CardGroup cols={2}>
  <Card title="EVV to paid claim" icon="route" href="/guides/evv-to-claim">
    What happens after the first visit.
  </Card>

  <Card title="Credentialing a caregiver" icon="badge-check" href="/guides/credentialing-a-caregiver">
    Getting an attendant ready to assign.
  </Card>
</CardGroup>