The CareCentrix Model
CareCentrix partners with health plans to manage home health benefits provided to people who are enrolled in their plans. The diagram below illustrates how CareCentrix partners with health plans, local home health agencies, and home medical equipment companies to ensure the delivery of appropriate and timely home health services.
- When physicians prescribe home health services, they check the health plan benefit structure, determine if the health plan partners with CareCentrix, and send orders for the home health services to CareCentrix for delivery.
Once CareCentrix receives the order, we check the following:
- Is the person insured by the insurance company?
- Does the insurance plan cover the services ordered?
- Do the services ordered meet medical guidelines for the diagnosis?
If the answer is "yes" to all three questions, CareCentrix approves the request and sends the orders to a contracted local home health agency that has agreed to provide these services to the individual. CareCentrix does not provide any home health services directly; rather, we contract with local home health agencies certified by national accreditation standards to provide the prescribed services. This allows patients to have greater choice and flexibility in service providers.
If the answer is "no" to any of the three questions above, CareCentrix notifies the provider with an explanation of why CareCentrix cannot process the order for services.
The home health provider delivers the prescribed services to the patient's home by the "Start of Care" date. Start of Care is a term that means the date the physician requests services to begin.